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RESUME 


LECTURES  ON  ANATOMY 


Edmond  Souchon,  M.  D.5 

PROFESSOR    OF    ANATOMY    AND    CLINICAL    SURGERY 
TULANE    UNIVERSITY   OF    LOUISIANA. 


NEW  ORLEANS: 

L.  Graham  &  Son,  Ltd.,  Printers,  207-211  Baronne  St. 

1895. 


PREFACE. 


This  simple  resume  of  the  Lectures  on  Anatomy,  delivered  be- 
fore the  Medical  Students  of  the  Tulane  University,  is  intended 
solely  to  assist  them  in  the  study  of  the  most  important  points 
of  this  branch,  which  is  one  hard  to  teach,  hard  to  learn,  hard  to 
remember  and  yet  of  great  importance,  since  it  is  the  foundation 
of  all  medical  studies. 

It  is  a  branch  which  can  not  be  guessed. 

It  is  one  which  can  only  be  learned  practically,  and  which  it 
is  almost  impossible  to  the  greatest  number  to  study  after  leav- 
ing the  college ;  hence  another  reason  for  studying  it  well  once 
and  at  once. 

This  resume  should  be  carefully  studied  at  home  by  the  stu- 
dents before  coming  to  the  college.  The  resume  of  the  coming 
lecture  should  be  studied  a  day  or  two  in  advance  to  profit  well 
by  the  lecture,  the  dissections,  the  drawings  and  the  microscopic 
preparations  which  may  be  exhibited  at  the  lecture.  The  resume 
of  the  lecture  of  the  day  should  be  well  studied  at  night.  After 
a  set  of  organs  have  been  described  the  resume  of  those  organs 
should  be  studied  over. 

All  that  does  not  require  to  be  seen  to  be  remembered  has 
been  left  out  of  this  resume. 

In  order  to  assist  the  students  in  studying  over  and  over,  a 
list  of  numbered  questions  with  corresponding  numbers  in  the 
text  has  been  placed  at  the  end  of  the  book.  It  will  enable  them 
to  examine  themselves  and  to  become  familiar  with  those  ques- 
tions, which  will  be  the  same  that  they  will  have  to  answer  in 
the  examining  room. 

To  assist  the  students  also  in  the  Dissecting  Rooms,  the  poste- 
rior surface  of  the  organs  is  described  last,  though  systematically 
it  should  come  second.  But  as  this  study  implies  a  removal  of 
the  organ  or  a  great  disturbance  in  the  parts  not  yet  studied, 
those  parts  should  be  studied  first  and  then  the  posterior  surface. 

EDMOND  SOUCHON,  M.  D. 


RESUHE  OF  GENERAL    HISTOLOGY. 


CELLS. 

1  Shape.  Cells  are  spherical  or  lenticular,  polygonal  or  cu- 
bical, cylindrical  or  columnar,  conical  or  pyriform,  spindle- 
shaped,  stellate  and  prickly. 

Number.     Cells  form  either  single  layers  or  many  layers 
(stratified  or  laminated). 

2  Structure.  Cells  are  composed  of  a  cell- membrane  and  of 
cell-contents  or  protoplasm,  which  is  a  fluid  containing  granu- 
lations, pigment  and  a  nucleus,  containing  itself  a  fluid  and 
a  nucleolus. 

Some  cells,  such  as  the  white  blood  corpuscles,  have  no 
cell  membrane,  and  are  formed  of  a  mass  of  jelly-like  matter 
with  or  without  a  nucleus. 

The  nucleus  is  a  little  cell  in  itself. 

Some  cells,  such  as  the  blood  cells  in  man,  have  no  nucleus. 

Some  cells  have  many  nuclei,  such  as  the  giant  cells  of  the 
red  marrow  of  bones. 

The  nucleolus  is  comparatively  unimportant . 

3  The  Vital  Properties  of  Cells  are  absorption,  assimila- 
tion, growth,  secretion,  excretion,  motion  (ameboid  or  cili- 
ated), and  death  or  destruction  (by  desquamation,  dissolu- 
tion, fatty,  pigmentary  or  calcareous  degeneration),  and 
multiplication  by  gemmation  or  budding,  and  by  segmenta- 
tion or  cleavage. 

EPITHELIAL  TISSUE. 

4  Definition.  Epithelial  tissue  is  formed  of  cells  lining  the 
surface  of  the  skin,  mucous  membrane  and  glands.  It  is 
almost  always  stratified. 

The  epithelial  tissue  of  the  skin  is  called  the  epidermis} 
that  of  the  mucous  membrane  and  glands  is  called  the 
epithelium. 

ENDOTHELIUM. 

5  Definition.  Endothelium  is  the  cells  lining  the  interior  of 
the  heart,  blood  vessels  and  serous  membranes.  It  is 
always  in  a  single  layer. 

CONNECTIVE  TISSUE. 

6  Varieties.     It  presents  the  following  varieties : 

1st,  the  transparent ; — 2d,  the  granular ; — 3d,  the  fibril- 
lated  (presenting  lymph  spaces  and  lymph  corpuscles)  :  — 


4  TISSUES. 

4th,  the  corpusculated  (presenting  the  so-called  connective 
tissue  corpuscles)  ; — 5th,  the  pigmented  ; — 6th,  the  mucoid 
or  gelatinous  formed  by  large  connective  tissue  corpuscles 
which  branch  and  anastomose  so  as  to  form  alveoles ; — 7th, 
the  adenoid,  lymphoid  or  retiform,  formed  of  branched 
corpuscles  forming  alveoles  filled  with  lymphoid  cells. 

FIBROUS  TISSUE. 

7  Definition.  Fibrous  tissue  is  formed  of  closely  united 
bundles  of  connective  tissue. 

ELASTIC  TISSUE. 

8  Definition.  Elastic  tissue  is  composed  of  flattened  band- 
like fibres  much  wider  than  those  of  the  connective  tissue. 
It  curls  when  cut. 

Varieties.  It  presents : — 1st.  A  variety  characterized  by 
narrow  fibres. — 2d.  A  variety  characterized  by  broad  fibres 
with  notched  edges  and  perforated  substance. 

ADIPOSE  TISSUE. 

9  Definition.  Adipose  tissue  is  formed  of  fibrils  of  con- 
nective tissue  in  the  meshes  of  which  are  deposited  fat  cells. 
Structure,  Fat  cells  have  a  distinct  membrane,  contain 
fluid  oil  and  a  nucleus. 

GLANDULAR  TISSUE. 

10  Varieties  and   Characters. 

1st.  The  Racemose  Glands  resemble  a  bunch  of  grapes. 

The  dilatations  are  the  acini,  and  the  stems,   large  and 
small,  are  the  ducts. 
They  are  simple  or  composite. 

2d.  The  Tubular  Glands  have  the  form  of  a  canal. 

They  are  simple  or  composite,  and  straight  or  convoluted, 
and  with  a  mere  closed  extremity  or  an  extremity  which 
terminates  by  a  dilatation  or  pouch. 

3d.  The  Open  Glandular  Follicles  are  vesicles  which 
present  a  small  opening  through  which  the  secretions  are 
discharged. 

4th.  The  Closed  Glandular  Follicles  are  vesicles  de- 
prived of  opening  and  discharging  their  contents  by  rupt- 
ure (ovaries).  They  are  not  to  be  confounded  with  the  fol- 
licles of  the  lymphoid  organs,  such  as  isolated  follicles  of 
the  small  intestines,  Peyer's  patches,  lymphatic  gland 
follicles. 

11  Structure  of-  Glands.  In  a  general  way  the  bottom  of  the 
gland  is  the  secreting  part  and  is  usually  lined  and  filled 
with  peculiar  gland  cells; — the  excretory  ducts  are  lined  by  a 
columnar  epithelium. 


PECULIARITIES  OF  THE  TISSUES.  5 

PECULIARITIES  OP  THE  TISSUES. 

N.  B. — Peculiarities  are  points  which  are  usually  special 
to  a  tissue  or  organ  alone,  seldom  to  two  or  three. 

12  Peculiarities  of  Epithelial  Tissue. 

It  is  found  ou  all  surfaces  in  contact  with  the  exterior 
directly  (skin,  mucous  surfaces) — It  is  always  laminated. — 
The  Deep  Cells  are  always  round  or  oval  and  soft. — The 
Superficial  Cells  have  little  or  no  vitality. — It  is  deprived  of 
vessels. — Nerve  Fibrils  form  hair-cells,  in  some  places, 
which  terminate  between  the  cells. 
Peculiarities  of  Endothelium. 

It  is  found  in  the  cavities  which  do  not  communicate  with 
the  exterior  (serous  surfaces) — It  is  always  in  a  single 
layer. 

13  Peculiarities  of  Connective  Tissue. 

The  most  common  variety  is  the  fibrillated. — The  fibres 
are  round  and  wavy. — The  corpuscles  present  branches  or 
processes. — It  has  no  capillaries  distributed  to  it  properly. 
Peculiarities  of  Fibrous  Tissue. 

Is  dense  connective  tissue. 
Peculiarities  of  Elastic  Tissue. 

It  curls  when  cut — The  broad  variety  presents  holes  and 
forms  the  fenestrated  membranes — It  has  no  capillaries. 

14  Peculiarities  of  Adipose  Tissue. 

It  presents  fat  cells  in  meshes  of  connective  tissue — It 
has  capillaries ;  they  form  a  network  around  each  fat 
lobule. 

15  Peculiarities  of  Glandular  Tissue. 

The  Racemose  Glands  are  found  in  a  general  way  on  the 
skin  and  on  the  mucous  membranes. — The  capillaries  are 
peculiar. 

In  Resume,  the  following  are  racemose  glands: — Glands 
of  the  mucous  membrane  of  the  intestinal  tract  from  the 
lips  to  the  cardia,  but  not  further,  except  the  duodenal 
gland  —  The  Salivary  Glands  are  compound  glands  —  The 
Liver. —  The  Pancreas. —  (Hands  of  the  mucous  membrane 
of  the  bladder — Prostate  (Hands  —  Cowpers'  Glands  — 
Glands  of  the  mucous  membrane  of  the  Urethra. —  Glands 
of  mucous  membrane  of  larynx,  trachea,  bronchi  —  The 
Lungs  are  a  sort  of  racemose  glands. — The  Glands  of 
mucous  membrane  of  the  Nasal  Cavities — Lachrymal 
Glands  and  Caruncula. —  Glands  of  the  Skin:  the  Sebace- 
ous. 

Racemose  Glands  present  lobes,  lobules  and  acini. 

Some  Racemose  Glands  present  an  am  xsonj  </land:  par- 
otid, pancreas,  lachrymal,  duodenal  glands.  Sonic  have 
two  or  more  excretory  ducts:  sublingual,  pancreas,  lach- 
rvmal. 


6  DESCRIBE  AN  ORGAN. 

The  Tubular  Glands  are  found  in : 

The  nxucous  membrane  of  Digestive  Tract  from  the  Cardia 
to  the  Anns  —  The  Kidneys  are  a  compound  branching, 
csecal  tubular  gland. — The  Testicles,  also. —  The  Sweat 
Glands  of  the  Skin  are  compound  convoluted  tubular 
glands. 

The  Closed  Follicular  or  Lymphoid  Glands  are :  the  Ton- 
sils-— Isolated  follicles  of  intestines — Peyer's  Patches  — 
Spleen — Supra-renal  capsules  —  Thyroid  Body — Thymus — 
Pituitary  Body. 

There  is  but  one  True  Follicular  Gland:  the  ovaries. 

Some  Glands  have  reservoirs  on  the  course  of  their  ducts : 
the  liver  has  the  gall-bladder,  the  kidneys  the  urinary- 
bladder,  the  testicles  the  seminal  vesicles,  the  lachrymal 
gland  has  the  lachrymal  sac. 

Some  Glands  have  a  twisted  duct,  Wharton's  duct,  cystic 
duct,  epididymis,  sweat  glands. 

Capillaries  —  In  the  Racemose  and  Follicular  Varieties  the 
capillaries  form  a  network  around  the  lobules  —  In  the 
Tubular  kind  the  capillaries  run  parallel  to  the  tubes  —  On 
cross-section  they  present  a  radiating  arrangement. 

1G     Guide  to  Describe  an  Organ. 

f  Wit  en  it  is  desired  to  describe  it  in  detail.  J 

a     Definition.     Synonymy,  Etymology,  History. 

b     Division  of  the  Organ  into  separate  portions. 

c  Number.  Simgle  or  Double  —  Supernumerary  organs. 
Absence  of  the  organ. 

d  Dimensions.  1st.  Relative  Size,  or  size  compared  to  that 
of  other  organs  or  to  familiar  objects.  2d.  Absolute  Size: 
Diameters,  transverse,  vertical,  antero-posterior.     Calibre. 

e  Situation.  1st.  General  Situation,  or  region  it  occupies. 
2d.  Relative  Situation,  or  compared  to  the  surrounding  or- 
gans. 

/'  Direction.  1st.  Compared  with  axis  of  the  body.  2d.  Com- 
pared with  its  own  axis. 

g  rieans  of  Fixity.  Vascular  connections,  adhesions,  liga- 
ments ;  supported  by  other  organs. 

h  Mobility.  1st.  Intrinsic  Mobility,  or  mobility  of  the  whole 
organ,  or  a  part  of  it.  2d.  Extrinsic  Mobility,  or  mobility 
communicated  by  other  organs.  3d.  Extent  of  Mobility. 
4th.   Exceptional  Mobility. 

i  Shape.  1st.  Compared  to  a  geometrical  figure.  2d.  Com- 
pared to  the  shape  of  a  familiarly  known  object. 

j     Surfaces: 
Synonymy. 

Direction:  forwards  or  backwards,  above  or  below,  inter- 
mediate direction. 


DESCRIBK  AN  ORGAN.  I 

Shape:  plane,  concave  or  convex  in  the  vertical  or  trans- 
verse direction. 

Peculiarities:  projections  (folds,  processes,  ridges  or 
crests,  tubercles,  protuberances) — depressions,  orifices 
(size,  shape,  boundaries,  structure,  contents),  blind  fora- 
mina—  grooves  and  canals  (depth,  extent,  contents,  vessels, 
or  nerves  or  organs).  When  enumerating  peculiarities,  begin 
on  the  median  line  and  then  on  the  sides ;  proceed  from  be- 
fore backwards,  or  from  within  outwards,  or  from  above 
downwards. 

Relations:   With  skin  (/.  e.  to  that  part  of  the  surface  it 
corresponds)  or  with  bones,  joints,  muscles,  viscera,  ves- 
sels and  nerves. 
Borders: 

Synonymy. 

Dimensions. 

Directions:  1st.  Relative  Direction,  vertical,  horizontal, 
oblique,  forwards  or  backwards,  or  above  or  below,  or  in- 
wards or  outwards.  2d.  Absolute  Direction,  straight,  sinu- 
ous, concave  or  convex. 

Shape:  Blunt  or  sharp,  or  beveled  at  the  expense  of  one 

surface  or  the  other. 

Peculiarities,  }        r.  ,. 

r>  -,  ,■  >-as  tor  surfaces. 

Relations,       J 

All  Thick  Borders  ought  to  be  subdivided  into  two  edges  or 
lips  and  an  interstice.  Give  for  each :  peculiarities,  inser- 
tions and  relations. 

Angles  or  Extremities:   same  as  borders. 
Base  and  Apex:   same  also. 
Structure : 

Color. 

Consistency:   Density,   Friability,  Elasticity,  Retractility. 

Envelopes  or  Goats:  Thickness,  Resistance,  Elasticity.  Ex- 
ternal Surface  (relations,  adhesions).  Internal  surface  (re- 
lations, adhesions,  processes  from  internal  surface,  reflec- 
tion into  the  interior  of  the  organ).  Stroma  :  is  delicate  or 
apparent;  is  composed  of  connective  tissue,  or  elastic  or 
smooth  muscular  fibres. 

Proper  or  Characteristic  Elements:  Cells,  Tubes,  Fibres. 
Prisms. 

Vessels:   Capillaries,  Arteries,  Veins,  Lymphatics. 

Nerves. 
Excretory   Duct  of  a  Gland    (as  a  separate  organ). 
Lining  Membrane  of  a   Hollow  Organ  :    Thickness,  Con- 
sistency. Elasticity,  Adherent  Surface  (degree  of  adhesion)  : 
Free  Surface:  color,  peculiarities,  epithelium,  glands. 
Chemical  Composition  :  Organic.  Inorganic  Elements. 
Development  or  Anatomy  of  the  Ages. 
Peculiarities    or    Varieties,    or    Anomalies    due    to    Sex. 
Habits,  Trades,  Constitutions,  Individualities.  Nationalities. 
Races. 


LIPS — CHEEKS — VESTIBULE — TEETH . 


RESUME  OF  THE  DIGESTIVE  ORGANS. 

17  Enumeration.  The  organs  concerned  in  digestion  are  the 
lips,  the  cheeks,  the  vestibule,  teeth,  tongue,  hard  and  soft 
palates,  tonsils,  parotid,  submaxillary  and  sublingual  glands ; 
the  pharynx,  oesophagus,  stomach,  duodenum,  jejunum, 
ileum,  caecal  appendix,  caecum,  ascending  colon,  transverse 
colon,  descending  colon,  sigmoid  flexure,  rectum,  anus, 
liver,  pancreas  and  spleen. 

LIPS. 

18  Structure.  The  lips  are  composed: — 1st,  of  a  Cutaneous 
layer; — 2d,  of  a  muscular  layer  formed  principally  of  the 
orbicular  muscle,  closely  attached  to  the  skin; — 3d,  of  a 
cellulo -glandular  layer  formed  of  loose  areolar  tissue  and 
simple  racemose  glands ; — the  labial  artery  runs  through  the 
layer; — 1th,  of  a  mucous  layer. 

N~.  B. — The  lymphatics  of  the  median  line  of  the  lower  lip 
discharge  into  the  digastric  glands — and  the  other  lym- 
phatics of  both  lips  discharge  into  the  submaxillary  lym- 
phatic glands. 

CHEEKS. 

19  Structure.  The  cheeks  are  formed : — 1st,  of  a  Cutaneous 
layer; — 2d,  of  an  adipose  layer  represented  specially  by  a  lit- 
tle mass  of  fat  situated  between  the  buccinator  and  the 
masseter; — 3d,  of  &  muscular  layer,  formed  posteriorly  by 
the  masseter  and  anteriorly  by  the  buccinator  pierced  by 
Steno's  duct; — 4th,  of  a  glandular  layer,  represented  by  a 
small  group  of  simple  racemose  glands,  called  the  molar 
glands,  and  clustered  on  the  buccinator,  where  Steno's  duct 
perforates  it; — 5th,  of  a  mucous  layer,  which  is  covered  with 
microscopic  papillae. 

VESTIBULE. 

20  Definition.  Is  the  space  limited  in  front  by  the  lips  and 
cheeks  and  behind  by  the  teeth. 

When  the  teeth  are  clinched,  the  vestibule  communicates 
with  the  mouth  proper  by  an  opening  limited  by  the  last 
molar  teeth,  and  the  vertical  branch  of  the  inferior  maxilla. 

THE  TEETH. 

21  Number.  There  are  two  sets. — The  temporary  or  milk  teeth 
number  twenty,  ten  for  each  jaw. 

The  permanent  set  number  thirty-two,  sixteen  for  each 
jaw;  two" central  incisors,  two  lateral  incisors,  two  canines, 
four  small  molars  or  bicuspids,  six  large  molars  or  multi- 
cuspids, the  last  of  which  are  called  the  wisdom  teeth. 


GUMS — TONGUE.  9 

Each  tooth  presents  ;i  crown,  a  neck,  a  root  or  fang. 
Shape.  The  Incisors  have  a  cutting  crown  and  a  single 
root; — the  Canines  have  a  conical  crown  and  a  single,  but 
long  root; — the  Small  Molars  have  a  crown  presenting  two 
points  (biscupids),  a  single  root,  but  broad  and  slightly 
grooved ; — the  Large  Molars  have  a  crown  presenting  four 
points  (multicuspids),  and  from  two  to  five  roots; — the 
Wisdom  Tooth  has  the  smallest  crown  and  presents  but  a 
single  root,  but  it  is  very  broad  and  deeply-grooved. 

22  Structure.     The    Crown    possesses     two    envelopes, — the 

Cuticle  of  the  Enamel,  which  has  no  apparent  structure, 
— and  the  Enamel  itself,  composed  of  prismatic  fibres  dis- 
posed in  superimposed  layers  and  having  a  different  direc- 
tion in  each  layer. 

The  Root  has  also  two  envelopes, — the  Alveolar  Periosteum 
— and  the  Cement,  which  resembles  bony  tissue,  presenting 
cement  corpuscles  and  canalicules. 

Tlte  Proper  Substance  of  the  Teeth  is  the  Ivory  or  Dentine; 
— it  exists  in  the  crown  and  root  alike  : — it  is  composed  of 
canalicules  extending  from  the  cavity  of  the  tooth  to  the 
enamel  and  cement. 

The  Interior  of  the  Teeth  presents  a  cavity  containing  the 
Pidp  of  the  Tooth, — it  is  a  projection  of  the  alveolar  perios- 
teum,— and  is  composed  of  delicate  connective  tissue  with 
capillaries  and  nerve  fibres. 

THE  GUMS. 

23  The    Gums   are   formed    of  thickened   mucous   membrane 
covering  the  alveolar  borders. 

THE  TONGUE. 

24  Shape.     The  tongue  is,  at  rest,  triangular  aud  flattened. 
The  Base  or  Root  is  the  posterior  part. 

The  Apex  or  Tip  is  the  free  end. 

The  Under  Surface  is  attached  along  the  middle  of  the 
floor  of  the  mouth,  and  presents  a  fold  of  mucous  mem- 
brane called  the  frenum, — on  the  side  of  which  are  the 
openings  of  the  ducts  of  Wharton ; — this  attached  portion 
is  the  body. 

The  Upper  Surface  presents  the  papilla? — and  the  glands 
of  the  mucous  membrane. 

25  Structure. 

The  riucous  Membrane  presents  on  the  anterior  two-thirds 
the  papilla1,  which  are  the  Circumvallate  or  Calyciform. — The 
Capitate  or  Fungiform, — and  the  Conical  or  Filiform. 

They  are  all  processes  or  projections  of  the  mucous  mem- 
brane and  have  the  same  structure  as  that  membrane, — 
the  circumvallate  and  the  capitate  present,  buried  in  the 
epithelium,  the  taste  goblets,  which  are  a  mode  of  termina- 
tion of  the  fibrils  of  the  gustatory  nerve. 


10  PALATES. 

The  fluscles  of  the  Tongue  are:  the  Genio-hyoglossus , 
which  is  the  protruder ; — the  Myoglossus,  which  is  the  de- 
pressor or  retractor,  or  muscle  which  draws  the  tongue  in  ; 
— the  Styloglossus,  which  is  the  elevator  muscle ; — the  Lin- 
guals,  which  make  the  tongue  convex  from  before  back- 
ward ; — the  Palato-pharyngeus,  or  constrictor  of  the  poste- 
rior arches, — and  the  Palato-glossus,  or  constrictor  of  the 
anterior  arches. — The  tongue  possesses  also  Intrinsic  fibres 
which  curve  it  into  a  gutter  and  give  it  the  various  other 
shapes  it  is  susceptible  of  having. 

The  Nerves  of  the  Tongue  are  the  Lingual,  from  the  In- 
ferior maxillary,  which  is  the  gustatory  nerve ; — the  Glosso- 
pharyngeal,  which  skives  sensibility  to  the  mucous  membrane 
of  the  root, — and  the  Hypoglossal,  which  is  the  motor  nerve 
of  the  tongue. 

HARD  PALATE. 

26  Shape  and  Consistency.  Some  palates  are  deep  and  others 
are  shallow. — In  some  the  mucous  membrane  is  soft  and  in 
others  it  is  hard. — Both  the  shape  and  consistency  are  im- 
portant factors  in  fitting  plates  of  teeth. 

Structure.  The  hard  palate  is  composed, — 1st,  of  a  Mu- 
cous layer  closely  adherent  to  the  periosteum  in  the  anterior 
third  of  the  palate ; — 2d,  of  a  Glandular  layer,  composed  of 
simple  racemose  glands,  which  are  more  numerous  in  the 
posterior  third; — 3d,  of  an  Osseous  layer,  formed  in  front 
by  the  palatine  process  of  the  superior  maxilla  and  behind 
by  the  horizontal  plate  of  the  palate  bones. — The  Arteries 
are  the  descending  palatine  from  the  internal  maxillary,  and 
the  ascending  palatine  from  the  facial. 

SOFT  PALATE. 

27  Shape.     Is  quadrilateral. 

The  Anterior  Surface  is  concave,  and  smooth. 

The  Posterior  Surface  is  convex  and  is  continuous  with  the 

floor  of  the  posterior  nares. 

The  Upper  or  Adherent  Border  is  attached  to  the  posterior 

margin  of  the  hard  palate. 

The  Lower  or  Free  Border  presents  on  the  median  line  the 

Uvula, —  and  on  each  side  the  Anterior  and  the   Posterior 

Pillars  of  the  fauces. — Between  the  arches  are  found  the 

Tonsils. — The  Strait  or  Passage  between  the  arches  of  the 

two  sides  is  the  Isthmus. 

28  Structure.  The  Soft  Palate  is  composed  from  below  up- 
ward : 

1st.  Of  a  Lower  mucous  layer  lined  with  pavement  epi- 
thelium.— 2d.  Of  a  Thick  layer  of  simple  racemose  glands. — 
3d.  Of  a  Fibrous  layer  or  fascia  attached  to  the  bones  of  the 
hard  palate. — 4th.  Of  a  Muscular  layer  composed  of  the 
Elevator  of  the  Uvula,  the  Elevator  of  the  palate,  the  Ten- 


TONSILS — PAROTID  GLANDS.  11 

sor  of  the  palate,  the  Constrictor  of  the  anterior  arches, 
the  Constrictor  of  the  posterior  arches. — 5th.  Of  a  s< <<>,i<l 
thinner  layer  of  simple  racemose  glands. — 6th.  Of  an 
npper  mucous  layer  lined  with  columnar  epithelioma. 

TONSILS. 

29  Shape.     The  Tonsils  resemble  an  almond. 

The  Free  Surface  presents  a  number  of  orifices  or  pouches. 

The  Deep  or  Adherent  Surface  rests  on  the  fascia  of  the 

pharynx — and  is  not  far  from  the  internal  carotid  artery 

and  the  apex  of  the  parotid  giand. 

The   Upper  Extremity   presents   above   it  a  little   recess 

called  the  Supra-tonsiUar  fossa . 

The  Lower  Extremity  is  separated  from  the  base  of  the 

tongue  by  a  tract  of  glands. 

Structure.     The  tonsils  are  composed  of  an  agglomeration 

of  lymphoid  follicles. 

PAROTID  GLANDS. 

30  Shape.  The  Parotid  gland  has  the  shape  of  a  flattened 
prism  filling  the  cavity,  called  the  Parotidean  Cavity,  with 
the  base  expanding  externally  under  the  skin. 

The  Anterior  Surface  is  in  relation  with  the  organs  form- 
ing the  anterior  wall  of  the  parotidean  cavity,  which  are 
from  outwards  inwards  ;  the  ramus  of  the  lower  jaw,  the  ex- 
ternal carotid  artery,  the  internal  maxillary  artery  and  the 
internal  pterygoid  muscle. 

The  Posterior  Surface  is  in  relation  with  the  organs  form- 
ing the  posterior  wall  of  the  parotidean  cavity,  which  are 
from  outwards  inwards ;  the  mastoid  process,  the  styloid 
process,  the  stylian  muscles,  the  facial  nerve,  the  internal 
jugular  vein,  the  internal  carotid  artery,  the  glosso-pharyn- 
geal  and  the  hypoglossal  nerves. 

The  Upper  Border  is  in  relation  with  the  external  auditory 
canal  and  the  petrous  bone. 

The  Lower  Border  is  in  relation  with  the  posterior  ex- 
tremity of  the  submaxillary  gland,  from  which  it  is  separa- 
ted by  a  fibrous  septum.  , 

The  Apex  extends  to  the  pharynx,  to  the  point  correspond- 
ing to  the  tonsil. 

The  Base  spreads  on  the  cheek  below  the  ear — and  is  cov- 
ered by  the  skin,  the  platysma  and  superficial  fascia  : — its 
posterior  edge  rests  upon  the  sterno-mastoid  ; — its  anterior 
edge  rests  upon  the  masseter ; — its  upper  edgi  is  notched  to 
accommodate  the  external  auditory  canal: — its  lower  "I;/' 
extends  down  to  near  the  angle  of  the  jaw. 

31  Structure.  The  parotid  is  a  compound  racemose  gland. — 
The  excretory  duct  is  the  Duct  of  Steno,  which  emerges  from 
the  anterior  edo-e  of  the  base,   runs  forward  parallel  to  the 


12        SUBMAXILLARY  GLANDS — SUBLINGUAL  GLANDS. 

zygoma  to  the  anterior  border  of  the  masseter,  where  it  per- 
forates the  buccinator  on  a  level  with  the  second  npper  mo- 
lar tooth. — Its  walls  are  very  thick  and  its  cavity  very  small. 

SUBMAXILLARY  GLANDS. 

32  Shape.  The  submaxillary  gland  has  the  shape  of  a  flat- 
tened, three-sided  prism. 

The  Superficial  or  Under  Surface  is  covered  by  the  skin, 
platysma  and  cervical  fascia; — the  facial  artery  crosses  its 
back  part. 

The  External  Surface  is  in  relation  with  the  submaxillary 
fossa  of  the  maxilla. 

The  Internal  Surface  presents  a  process  which  extends 
backwards  towards  the  parotid  gland, — a  process  which  ex- 
tends forwards  .over  the  border  of  the  mylo-hyoid  muscle 
and  reaches  the  sublingual  gland. 

The  Anterior  Extremity  is  rounded — and  is  situated  on  the 
outside  of  the  mylo-hyoid. 

The  Posterior  Extremity  is  separated  from  the  parotid  by 
a  band  of  fascia. 

33  Structure.  The  Submaxillary  Gland  is  a  compound  race- 
mose gland. — Its  excretory  duct  is  the  Duct  of  Wharton; — 
it  originates  on  the  internal  surface  of  the  gland, — is 
directed  forwards  along  the  lingual  artery  and  nerve — and 
opens  on  the  side  of  the  frenum  at  the  apex  of  a  twisted 
papilla. — Its  walls  are  much  thinner  than  those  of  the  duct 
of  Steno,  and  its  cavity  is  much  larger. 

SUBLINGUAL  GLANDS. 

34  Shape.     The  sublingual  glands  resemble  an  almond. 

The  External  Surface   is  in  relation  with  the  mylo-hyoid 

muscle. 

The  Internal  Surface  is  in  relation  with  the  hyo-glossus 

and  the  genio-hyo-glossus  muscles. 

The  Lower  Border  rests  on  the  mylo-hyoid. 

The  Upper  Border   is  attached  to  the  mucous  membrane, 

by   means   of  its  ducts ; — it   projects  on  the  floor  of  the 

mouth. 

The   Posterior   Extremity    extends  towards    the  anterior 

process  of  the  submaxillary  gland. 

The  Anterior  Extremity  is  in  relation  with  the  sublingual 

fossa  of  the  lower  maxilla. 

35  Structure.  The  Sublingual  Gland  is  a  racemose  gland. — 
Its  ducts  are  the  Ducts  of  Bivinus, — about  twelve  in  num- 
ber, opening  along  the  upper  border  of  the  gland — often 
several  small  dncts  form  a  single  one  called  the  Duct  of  Bar- 
tholin, which  opens  in  the  duct  of  Wharton,  or  separately. 


PHARYNX — (ESOPHAGUS.  13 


PHARYNX. 


:;()     Shape.     The  pharynx  is  funnel-shaped. 

The  Posterior  Surface  is  connected  by  loose  areolar  tissue 

with  the  cervical  column  and  its  muscles. 
The  Lateral  Surfaces  are  in  relation  with  the  styloid  pro- 
cess and  its  .muscles,  the  internal  and  common  carotid  arte- 
ries, the  jugular  vein  and  the  pneumo-gastrie,    glosso-pha- 
ryngeal,  hypoglossal  and  sympathetic  nerves. 
The  Anterior  Surface  is  incomplete, — and  presents  from 
upwards  downwards;    the  posterior  nares, — the  Eustachian 
tubes, — the   retro-Eustachian    fossa — the   aperture    of    the 
mouth, — the  base  of  the    tongue, — the    epiglottis   and  its 
folds, — the   opening  of  the    larynx, — the    two    pharyngo- 
laryngeal  grooves, — and  the  opening  of  the  oesophagus. 
The  Base  corresponds  to  the  basilar  process  of  the  occip- 
ital. 

The  Apex  is  continuous  with  the  oesophagus. 
87  Structure.  The  pharynx  is  composed  from  without  in- 
wards:— 1st,  of  a  layer  of  Areolar  tissue; — 2d,  of  a  super- 
ficial or  Muscular  fascia  covering  the  surface  of  the  mus- 
cles ; — 3d,  of  a  Muscular  layer  composed  of  the  superior, 
middle  and  inferior  constrictor  muscles,  and  the  stylo-pha- 
ryngeus,  which  is  the  elevator  muscle  of  the  pharynx  ; — 4th, 
of  a  Fibrous  or  Aponeurotic  layer  attached  to  the  bones, 
which  forms,  as  it  were,  the  skeleton  of  the  pharynx  and 
which  supports  the  muscles; — 5th,  of  a  Glandular  layer  of 
simple  racemose  glands ; — 6th,  of  a  Mucous  layer,  the  upper 
or  nasal  portion  of  which  is  lined  with  a  ciliated  epithelium 
and  the  balance  with  a  pavement  epithelium. 

(ESOPHAGUS.** 

38  Dimensions.  It  is  narrowest  at  its  commencement, — is 
also  narrow  opposite  the  fourth  dorsal  vertebra — and  is 
slightly  constricted  where  it  passes  through  the  diaphragm. 
Direction :  At  its  origin  it  is  on  the  median  line, — but  it 
soon  deviates  a  little  to  the  left  side  at  the  root  of  the  neck ; — 
it  then  returns  to  the  median  line — and  finally  deviates  again 
slightly  to  the  left  as  it  passes  through  the  diaphragm. — It 
follows  also  the  curvatures  of  the  spinal  column. 

39  Surfaces  and   Borders. 

In  the  Neck, — the  Anterior  Surface  is  in  relation  with  "the 
trachea  ; — the  Posterior  Surface  is  in  relation  with  the  verte- 
bral column ; — the  Lateral  Borders  are  in  relation  with  the 
carotid,  specially  the  left,  the  lobes  of  the  thyroid  body,  the 
recurrent  laryngeal  nerve. 

In  the  Thorax — the  Anterior  Surface  is  in  relation  with  the 
end  of  the  trachea,  arch  of  aorta  and  pericardium  ;  the  Pos- 
terior Surface  rests  upon  the  vertebral  column  above,  and 
below  on  the  thoracic  aorta   and  the   thoracic    duct ; — the 


14  ABDOMEN.       • 

Lateral  Borders  are  in  contact  with  the  pleura. — The  Pneu- 
mo-gastric  nerves  descend  along  with  it. 
The  Upper  Extremity  is  continuous  with  the  pharynx. 
The  Lower  Extremity  is  continuous  with  the  stomach. 

40  Structure.  The  oesophagus  is  composed : — 1st,  of  an  Ex- 
ternal Envelope  of  loose  areolar  tissue ; — 2d,  of  a  Muscular 
layer  composed  of  superficial  longitudinal  and  of  deep  circu- 
lar fibres ; — they  are  striped  fibres  above  and  smooth  below ; 
— 3d,  of  a  Cellulo -fibrous  and  Glandular  layer; — 4th,  of  a 
Mucous  layer  presenting  folds,  papillae  and  stratified  epi- 
thelium. 

THE  CAVITY  OF  THE  ABDOMEN. 

41  Shape.  The  cavity  of  the  abdomen  resembles  an  ovoid 
slightly  flattened  from  before  backwards. 

The  Anterior  Surface  or  Wall  is  formed  by  the  Abdominal 

Straight  muscles. 

The  Lateral  Surfaces  or  Walls  are  formed  by  the  Oblique 

and  Transverse  muscles. 

The  Posterior  Surface  or  Wall  is  formed  by  the  vertebral 

column,  the  pillars  of  the  diaphragm,  the  upper  portion  of 

the  Psoas  muscles  and  the  Square  Lumbar  muscles. 

The  Upper  Surface  or  Wall  or  Roof  is   formed   by  the 

diaphragm.- 

The  Lower  Surface  or  Wall  or  Floor  is  formed  by  the 

Psoas-iliac  muscles  in  the  iliac  fossa ; — in  the  middle  of  the 

abdomen  it  communicates  freely  with  the  pelvic  cavity. 

REGIONS  OF  THE  ABDOMEN. 

42  Dividing  Lines.— 1st,  if  two  Parallel  Circular  Lines  are 
drawn  round  the  body,  the  first  parallel  with  the  cartilages 
of  the  ninth  ribs  and  the  others  with  the  highest  point  of 
the  crest  of  the  ilium,  the  region  is  divided  into  an  upper,  a 
middle  and  lower  zone. — 2d,  if  two  Perpendicular  Parallel 
Lines  are  drawn  from  the  cartilage  of  the  eighth  ribs  down 
to  the  centre  of  Poupart's  ligament,  each  of  the  above  zones 
is  subdivided  into  three  parts  or  regions,  a  middle  and  two 
lateral. 

The  middle  of  the  upper  zone  in  the  Epigastric  Region,  or 
the  epigastrium,  and  the  two  lateral  are  the  right  and  left 
Hypochondriac  Regions,  or  hypochondria. 

The  central  region  of  the  middle  zone  is  the  Umbilical 
Region,  and  the  two  lateral  the  right  and  left  Lumbar  Regions 
or  the  Loins. 

The  middle  region  of  the  lower  zone  is  the  Hypogastric- 
Region, — and  the  two  lateral  the  right  and  left  Iliac  or  In- 
guinal Regions. 


ABDOMEN — PERITONE  I'M.  1 .") 

PARTS  CONTAINED  IN  THE  ABDOMINAL  REGIONS. 

43  Right  Hypochondriac  Region. — Liver, — gall  bladder, — 
duodenum, — right  angle  of  colon, — suprarenal  capsule, — 
upper  extremity  of  right  kidney. 

Epigastric  Region — Liver, — stomach, — pancreas, — aorta, 
thoracic  duct, — ascending  cava  vein. 

Left  Hypochondriac  Region — Liver, — stomach, — pancreas, 
— spleen, — left  angle  of  colon, — suprarenal  capsule, — upper 
extremity  of  left  kidney. 

44  Right  Lumbar  Region.  Coils  of  jejunum, — ascending 
colon, — lower  part  of  right  kidney. 

Umbilical  Region — Transverse  colon, — part  of  great  omen- 
tum,— part  of  mesentery, — duodenum  (3d  portion), — coils 
of  jejunum. 

Left  Lumbar  Region — Coils  of  jejunum, — descending 
colon, — lower  part  of  left  kidney. 

4o     Right  Iliac  Region.     Coils  of  ileum, — caecum  and  appen- 
dix,— ileo-ca?cal  valve, — ureter, — spermatic  vessels. 
Hypogastric  Region — Coils  of  ileum, — bladder  when  dis- 
tended,— uterus  in  pregnancy, — rectum. 
Left    Iliac   Region — Coils   of    ileum, — sigmoid    flexure, — 
ureter, — spermatic  vessels. 

PERITONEUM. 

46  Number  or  Divisions.  The  Parietal  Peritoneum  lines  the 
walls  of  the  abdomen ; — the  Visceral  Peritoneum  covers  the 
surface  of  the  organs. 

There  is  a  General  Peritoneal  Cavity, — and  a  Smaller  Cavity 
behind  the  stomach  enclosed  in  the  great  omentum  —  com- 
municating with  the  general  cavity  through  the  Foramen  of 
Winslow. 

47  Folds.  The  folds  or  ligaments  of  the  peritoneum  connected 
with  each  organ  are  the  following  : 

1st.  With  the  Stomach;  the  gastro-hepatic  omentum, — 
the  gastro-splenic, — the  gastro-colic  or  great  omentum. 

2d.      With  the  Small  Intestines:    the  mesentery. 

3d.  With  the  Large  Intestines:  the  meso-csecnm, —  the 
ascending  meso-colon, —  the  transverse  nieso-eolon, — the 
sigmoid  meso-colon, — and  the  meso-rectum. 

4th.  With  the  Bladder:  in  the  male, — the  recto-vesical 
folds  and  pouch, —  the  vesico-pubic  folds  and  pouch. 

5th.  With  the  Uterus:  the  recto-uterine  folds  —  and 
Douglas' pouch, — the  utero-vesical  folds  and  pouch  —  and 
the  broad  ligaments. 

Gth.  With  the  Liver:  the  coronary  ligament, —  the  trian- 
gular ligaments, —  the  suspensory  ligament. — and  the  gas- 
tro-hepatic omentum. 


16  STOMACH. 

48  Relations  of  the  Viscera  with  the  Peritoneum. 

The  stomach  is  entirely  surrounded  by  peritoneum. 
The  duodenum  is  uncovered  in  its  posterior  surface. 
The  small  intestines  are  entirely  surrounded  by  peritoneum. 
The  ca?cal  appendix  also. 

The  caecum  also,  usually;  sometimes  the  posterior  surface 
is  partly  uncovered. 

The  ascending-  colon  is  deprived  of !  peritoneum  on  its  poste- 
rior surface. 

The  transverse  colon  is  completely  surrounded  by  perito- 
neum. 

The  descending'  colon  is  deprived  of  peritoneum  on  its  pos- 
terior surface 

The  first  portion  of  the  rectum  is  entirely  surrounded  by 
peritoneum. 

The  second  portion  is  covered  only  in  front  and  partly  on 
the  sides. 

The  third  portion  is  entirely  free  of  peritoneum. 
The  liver  is  deprived  of  peritoneum  along  its  upper  border. 
The  pancreas  is  uncovered  at  the  posterior  surface  of  the 
body  and  head. 

The  spleen  is  completely  surrounded  by  peritoneum. 
The  supra-renal  capsules  are  free  behind. 
The  kidneys  are  uncovered  in  their  posterior  surface. 
The  pelvis  is  free  behind. 

The  ureters  are  uncovered  on  their  posterior  surface  all  along. 
The  anterior  surface  of  the  bladder  is  uncovered  when  the 
viscus  is  distended. 

The  posterior  surface  is  entirely  covered. 
The  lateral  surfaces  are  covered  only  on  their  upper  and 
posterior  parts. 

The  base  is  free  from  peritoneum. 

The  body  of  the  uterus,  the  Fallopian  tubes,  and  the  ovaries 
are  completely  surrounded  with  peritoneum. 
The  anterior  surface  of  the  neck  is  free  on  its  lower  half. 
The  posterior  surface  is  completely  covered. 
The  anterior  surface  of  the  vagina  is  free. 
The  posterior  surface  is  covered  on  its  upper  part  near  the 
neck. 

STOMACH. 

49  Shape.     The  stomach  is  irregularly  conical  and  bent  upon 
itself. 

The  Anterior  Surface  is  in  relation  with  the  liver,  the  ab- 
dominal walls  and  the  diaphragm. 

The  Upper  Border  is  concave; — it  gives  attachment  to  the 
gastro-hepatic  omentum; — it  is  in  relation  with  the  Spige- 
lian lobe  of  the  liver. 

The  Lower  Border  is  convex; — it  gives  attachment  to  the 
gastro-colic  omentum  ; — it  is  in  relation  with  the  transverse 
colon. 


DUODENUM.  17 

The  Left  Extremity  gives  attachment  to  the  gastro-splenic 
omentum; — it  is  in  relation  with  the  spleen. — It  presents 
the  oesophageal  opening  of  Gardia  continuous  with  the 
oesophagus  without  any  distinct  line  of  demarcation  exter- 
nally or  internally. 

The  Right  Extremity  is  the  Pylorus; — it  is  in  relation 
with  the  liver  in  front  and  behind  with  the  head  of  the  pan- 
creas and  the  duodenum. — It  presents  the  pyloric  opening 
or  the  pylorus  separated  externally  from  the  duodenum  by 
a  groove,  and  internally  by  a  round  prominent  muscular 
valve,  the  Pyloric  Valve. 

The  Posterior  Surface  is  in  relation  with  the  pancreas,  the 
aorta,  the  pillars  of  the  diaphragm  and  the  ascending  cava. 

50  Structure.  The  Stomach  is  composed: — 1st,  of  a  Serous 
coat,  formed  by  the  peritoneum  reduced  to  its  endothelial 
layer; — 2d,  of  a  layer  of  Longitudinal  Muscular  fibres 
formed  by  the  expansion  of  the  fibres  of  the  oesophagus  and 
of  the  duodenum  ; — 3d,  of  a  layer  of  Circular  Fibres; — 4th, 
of  a  layer  of  Oblique  Fibres; — 5th,  of  a  Submucous  layer  of 
Fibro- Areolar  tissue  ; — 6th,  of  a  Mucous  Coat  which  presents 
the  Hexagonal  crests  and  depressions — and  the  openings  of 
the  glands; — these  glands  are  the  Pyloric  or  Mucous  Tubular 
Glands  —  and  the  Cardiac  or  Peptic  Tubular  Glands, —  these 
presenting  peculiar  large  cells,  the  peptic  cells. 

The  layers  are  much  thinner  in  the  left  half  of  the  stom- 
ach than  in  the  right  half. 

DUODENUM. 

51  Shape.  The  duodenum  resembles  an  irregularly  shaped 
horseshoe  or  crescent. 

The  Anterior  Surface  is  in  relation  with  the  stomach. 
The  External  or  Convex  Border  is  in  relation  with  the  as- 
cending colon. 

The  Internal  or  Concave  Border  is  in  relation  with  the 
head  of  the  pancreas,  the  common  bile  duct  and  pancreatic 
ducts. 

The  Upper  or  Gastric  Extremity  is  separated  from  the 
stomach  by  a  groove  externally  —  and  internally  by  the 
pyloric  valve. 

The  Lower  or  Jejunal  Extremity  is  continuous  witli  the 
jejunum  without  any  line  of  demarcation; — the  superior 
mesenteric  artery  is  the  limit  between  the  two. 
The  Posterior  Surface  is  in  relation  with  the  pillar  of  the 
diaphragm,  the  ascending  cava,  the  supra-renal  capsule  and 
kidney. 

52  Structure.  The  Duodenum  is  the  thickest  and  largest  por- 
tion of  the  small  intestines. 

It  is  composed, —  1st,  of  a  Si  rous  Coat  formed  by  the  peri- 
toneum reduced  to  its  endothelial  layer: — 2d.  of  a  Layer  of 

9 


18  JEJUNUM — ILEUM. 

Longitudinal  Fibres; — 3d,  of  a  layer  of  Circular  Fibres; — 
4th,  of  a  Submucous  Fibro- Areolar  Layer; — 5th,  of  a  Mu- 
cous Goat  which  presents  —  the  openings  of  the  bile  duct 
and  pancreatic  ducts, — large  and  numerous  valvulae'conni- 
ventes — with  crest-like  villi, — tubular  glands  — and  race- 
mose glands  (glands  of  B runner). 

The  Villi  are  projections  of  the  mucous  membrane, — present- 
ing an  epithelial  layer  of  columnar  cells  —  a  stroma  formed 
of  connective  tissue  and  smooth  muscular  fibres, —  and  a 
cavity  in  the  centre,  occupied  by  a  ccecal  lacteal  vessel. 

JEJUNUM. 

53  Shape.  The  Jejunum  resembles  a  cylindrical  and  much 
convoluted  tube, —  forming  a  sort  of  square  or  cuboidal 
mass. 

The  Anterior  Surface  of  this  mass  is  in  relation  with  the 

great  omentum  and  the  umbilical  abdominal  walls. 

The  Upper  Surface  is  in  relation  with  the  transverse  colon 

—  and  stomach . 

The  Under  Surface   is   in  relation  with   the   coils  of  the 

ileum. 

The  Right  Surface  is  in  relation  with  the  walls  of  the  right 

lumbar  region  and  the  ascending  colon. 

The  Left  Surface  is  in  relation  with  the  walls  of  the  left 

lumbar  region  and  the  descending  colon. 

The  Upper  Extremity  is  separated  from  the  duodenum  by 

the  superior  mesenteric  artery. 

The  Lower  Extremity  is  continuous  with  the  ileum  without 

any  line  of   demarcation ; —  the   upper  two-fifths  form  the 

jejunum. 

The  Posterior  Surface  is  attached  by  the  mesentery  to,  and 

is  in  relation  with,  the  vertebral  column,  'aorta,  pillars  of 

the  diaphragm  and  ascending  cava  vein. 

54  Structure.  The  structure  of  the  jejunum  is  the  same  as 
that  of  the  duodenum, —  except  that  it  is  not  quite  so  thick, 
the  valvula?  are  more  numerous, — the  villi  are  exclusively 
conical, —  the  glands  are  exclusively  tubular  (Lieberkuhn) 
and  follicular  (isolated). 

ILEUM. 

55  Shape.  The  shape  of  the  ileum  is  that  of  a  much  convo- 
luted cylindrical  tube  —  forming  a  sort  of  square  or  cuboidal 
mass. 

The  Anterior  Surface  of  this  mass  is  in  relation  with  the 
hypogastric  abdominal  walls. 

The  Right  Surface  is  in  relation  with  the  walls  of  the  right 
iliac  region,  the  caecum,  the  iliac  and  the  psoas  muscles,  the 
external  and  internal  iliac  vessels. 


CiECAL  APPENDIX — CECUM.  1!) 

The  Left  Surface  is  in  relation   with  the  walls  of  the  Lefl 

iliac  region,  the  sign  mid  flexure,  the  iliac  and  the  psoas  mus- 
cles, and  the  external  and  internal  iliac   vessels. 
The  Upper  Surface  is  in  relation  with  the  coils  of  the  jeju- 
num. 

The  Under  Surface  dips  into  the  pelvis  —  and  is  in  relation 
with  the  bladder,  rectum  and  uterus. 

The  Upper  Extremity  is  continuous  with  the  jejunum, 
without  auy  apparent  line  of  demarcation; — the  lower 
three-fifths  form  the  ileum. 

The  Lower  Extremity  opens  into  the  caecum  and  presents 
the  Heo-ccecal  Valve, — which  has  the  shape  of  a  buttonhole 
—  and  presents  an  upper  and  lowrer  flap. 
The  Posterior  Surface  is  in  relation  with  the  lumbar  and 
sacral  columns,  the  aorta,  thoracic  duct  and  ascending  cava. 

56  Structure.  The  ileum  has  the  same  structure  as  the  jeju- 
num,—  except  that  it  is  much  thinner} — the  valvulce  —  and 
villi  are  smaller,  fewer  and  farther  between  ; — it  is  provided 
with  tubular  glands  and  isolated  follicles . 

It  alone  possesses  the  Agminated  Follicles  or  'Beyer's 
Patches, — which  occupy  the  free  border  of  the  intestines  — 
and  which  are  larger  and  the  more  numerous  as  Ave  approach 
the  ileo-ca?cal  valve. 

CMC  Ah  APPENDIX. 

57  Shape.     The  ca?cal  appendix  resembles  a  goose-quill. 

The  Surfaces  are  smoother  —  and  are  in  relation  with  the 

iliac  fossa  and  the  end  of  the  ileum. 

The  Lower  Extremity  is  closed. 

The    Upper    Extremity    opens   into    the    caecum  —  and  is 

guarded  by  a  valve. 

Structure.    It   is   composed: — 1st,  of   an   external   Serous 

Layer; —  2d,  of  a   layer  of  Longitudinal  Smooth  Muscular 

fibres,  uniformly  distributed  all  around  it; — 3d.  of  a   layer 

of  Circular  Fibres; — 4th,    of  a  Mucous  Coat   with   tubular 

glands. 

CECUM. 

58  Shape.     The  caecum  is  cuboiclal. 

The  Anterior  Surface  is  sacculated, —  as  are  all  the  others  ; 
— it  is  in  relation  with  the  coils  of  the  ileum  and  the  walls 
of  the  inguinal  region. 

The  External  Surface  is  in  relation  with  the  transverse  and 
oblique  muscles  and  the  crest  of  the  ileum. 
The  Internal   Surface  is    in    relation    with    the    ileo-csecal 
valve,  the  terminal  coil  of  the  ileum  and  the  caeca!   appen- 
dix. 

The  Apex  communicates  with  the  caeca!  appendix. 
The   Base  is  continuous  with  the  ascending  colon   without 
any  line  of  demarcation,  except  the  ileo-caeca!  valve. 


20  COLON. 

The  Posterior  Surface  gives  attachment  to  the  meso- 
caecum; — it  is  in  relation  with  the  iliac  muscle. 

59  Structure.  The  caecum  is  composed:  1st,  of  an  incomplete 
Peritoneal  coat; — 2d,  of  a  layer  of  Longitudinal  Muscular 
fibres  gathered  into  three  bandelettes; — 3d,  of  a  layer  of 
Circular  Fibres; — 4th,  of  a  Submucous  Fibro- Areolar  Layer; 
—  5th,  of  a  Mucous  Layer  —  presenting  saccules  and 
ridges, —  it  possesses  tubular  glands  and  isolated  follicles. 

ASCENDING  COLON. 

60  Shape.     The  ascending  colon  is  cuboidal. 

The  Anterior  Surface  is  sacculated, —  as  are  also  the  others  ; 
— it  is  in  relation  with  the  coils  of  the  intestines  and  the 
under  surface  of  the  liver. 

The  External  Surface  is  in  relation  with  the  transverse 
and  oblique  muscles. 

The  Internal  Surface  is  in  relation  with  the  small  intes- 
tines. 

The  Lower   Extremity  is  continuous  with  the  caecum, — 
from  which  it  is  separated  by  the  ileo-eaecal  valve. 
The  Upper   Extremity  forms   the  right  angle  or  bend — 
which  separates  it  from  the  transverse  colon ; — it  is  in  rela- 
tion with  the  under  surface  of  the  right  lobe  of  the  liver. 
The  Posterior  Surface  is  in  relation  with  the  iliac  crest, 
the  square  lumbar  muscle,  the  kidney  and  supra-renal  cap- 
sule. 
Structure.     The  ascending  colon  has  the  same  structure  as 


the  caecum. 


TRANSVERSE    COLON. 


61     Shape.     The  transverse  colon  is  cuboidal. 

The  Anterior  Surface  is  sacculated — and  so  are  the  others  ; 

— it  is  in  relation  with  the  liver,  the  abdominal  walls,  the 

gastro-colic  omentum  and  the  diaphragm  in  the  left  hypo- 

chondrium. 

The  Upper  Surface  is  in  relation  with  the  stomach  and 

liver. 

The  Under  Surface  is  in  relation  with  the  small  intestines. 

The  Right  Extremity  is  separated  from  the  ascending  colon 

by  the  right  angle  or  bend  of  the  colon. 

The  Left  Extremity  is  separated  from  the  descending  colon 

by  the  left  angle  or  bend  of  the  colon  ; — it  is  in  relation  with 

the  spleen  and  supra-renal  capsule. 

The  Posterior  Surface  gives  attachment  to  the  transverse 

meso-colon. 

Structure.    The  transverse  colon  has  the  same  structure  as 

the  ascending  colon  and  caecum. 


COLON — SIGMOID  FLEXURE — RECTUM.  21 

DESCENDING  COLON. 

(52     Shape.     The  descending  colon  is  cuboidal. 

The  Anterior  Surface  is  sacculated  like  the  others; — it  is 
in  relation  with  the  peritoneum,  the  diaphragm,  the  small 
intestines  and  the  abdominal  walls. 

The  External  Surface  is  in  relation  with  the  transverse  and 
oblique  muscles. 

The  Internal  Surface  is  in  relation  with  the  small  intes- 
tines. 

The  Upper  Extremity  is j separated  from  the  transverse 
colon  by  the  left  angle  of  the  colon  ; — it  is  in  relation  with 
the  spleen. 

The  Lower  Extremity  is  continuous  with  the  sigmoid  flex- 
ure without  any  line  of  demarcation  except  the  difference  in 
the  direction  of  the  organs  ; — the  crest  of  the  ileum  is  con- 
sidered the  line  between  the  two. 

The  Posterior  Surface   is  in  relation  with  the  supra-renal 
capsule,  the  kidney  and  square  lumbar  muscle. 
Structure.     The  Descending  Colon  has  the  same  structure 
as  the  other  colons  and  the  caecum. 

SIGMOID    FLEXURE. 

63  Shape.  The  sigmoid  flexure  is  cylindrical  and  forms  an 
italic  8. 

The  Anterior  Surface  is  in  relation  with  the  abdominal 
walls  and  the  intestinal  coils. 

The  Upper  Extremity  is  continuous  with  the  desceuding 
colon  without  any  line  of  demarcation, — the  limit  between 
them  being  the  crest  of  the  ileum. 

The  Lower  Extremity  is  continuous  with  the  rectum  with- 
out any  line  of  demarcation; — the  sacro-iliac  articulation  is 
considered  the  boundary  between  the  two. 
The    Posterior  Surface   gives   attachment  to   the   sigmoid, 
meso-colon. 

64  Structure.  The  sigmoid  flexure  is  twice  as  thick  as  the 
colon.  It  is  composed: — 1st,  of  a  Peritoneal  Coat  which 
usually  invests  it  completely  ; — 2d,  of  a  layer  of  Longitudinal 
Muscular  Fibres  which  are  still  disposed  in  bandelettes,  bu1 
closer  to  one  another  than  in  the  colons; — 3d,  of  a  layer  of 
Circular  Fibres; — 4th,  of  a  Submucous  Fibro-.  I  n  olar  Layi  r:  — 
5th,  of  a  Mucous  Coat  presenting  irregular  folds, — having 
tubular  glands  and  isolated  (dosed  follicles. 

RECTUM. 

65  Shape.  The  rectum  is  cylindrical, — but  is  nol  convoluted. 
Lateral  Surfaces  are  in  relation  with  the  pelvic  areolar  tis- 
sue. 

The  Anterior  Surface  is  concave : — it  is  in  relation  in  tin 


22    '  ANUS — PECULIARITIES  OF  THE  DIGESTIVE  TRACT. 

male  with  the  bladder,  prostate  and  seminal  vesicles ; — in 
the  female  it  is  in  relation  with  the  nterus  and  vagina. 
The  Posterior  Surface  is  convex; — it  is  in  relation  with 
the  sacrum  and  coccyx. 

The  Upper  Extremity  is  continuous  with  the  sigmoid  flex- 
ure. 

The  Lower  Extremity  is  continuous  with  the  anus; — the 
upper  edge  of  the'  strong  internal  sphincter  is  the  limit  be- 
tween the  two. 

66  Structure.  The  rectum  is  the  thickest  portion  of  the  in- 
testinal tract.  It  is  composed : — 1st,  of  a  Serous  Coat  which 
invests  it  completely  only  in  the  upper  third  ; — the  last  third 
is  deprived  of  it  entirely ; — 2d,  of  a  layer  of  Longitudinal 
Muscular  fibres  surrounding  all  the  bowel ; — 3d,  of  a  layer 
of  Circular  Fibres,  a  portion  of  which  forms  the  internal 
sphincter; — 4th,  of  a  layer  of  Submucous  Fibro- Areolar  Tis- 
sue;— 5th,  of  a  Mucous  Layer  provided  with  numerous  tubu- 
lar glands  and  isolated  follicles. 

ANUS. 

67  Shape.  The  anus  has  the  form  of  a  circular  ring  about  one 
inch  in  height. 

The  Lateral  Surfaces  are  in  relation  with  the  cellulo-adi- 

pose  tissue  of  the  ischio-rectal  fossa?. 

The  Anterior  Surface  is  in  relation  with  the  perineum. 

The  Posterior  Surface  is  in  relation  with  the  coccyx,  to 

which  it  is  attached. 

The  Upper   Extremity  is  continuous  with  the  rectum  and 

forms  an  angle  with  it ; — the  strong  edge  of  the  internal 

sphincter  is  the  limit. 

The  Lower  Extremity  is  continuous  with  the  skin. 

68  Structure.  The  anus  is  composed: — 1st,  of  a  layer  of 
Striped  Circular  Fibres  forming  the  external  sphincter ; — 2d, 
of  a  layer  of  Submucous  Fibro-Areolar  Tissue; — 3d,  of  a 
Muco- Cutaneous  Layer  presenting  pouch-like  depressions  sep- 
arated by  small  pillars; — it  is  provided  with  tubular  glands 
and  sebaceous  glands. 

PECULIARITIES  OF  THE  DIGESTIVE  TRACT. 

69  Guide.  Follow  Shape,  Surfaces,  Borders,  Extremities, 
Structure,  Vessels,  Nerves,  and  say  what  peculiarities  each 
presents,  if  any, 

Peculiarities  of  the  Lips. 

The  Epithelium  is  stratified,  i.  e.,  is  in  many  layers 
throughout. —  It  is  pavement  from  the  lips  down  to  the 
cardiac  orifice  of  the  oesophagus. —  It  is  columnar  from  the 
cardia  down  to  the  anus. 

All  the  Glands  are  racemose  to  the  cardiac  orifice  of  the 


PECULIARITIES  OF  THE  DIGESTIVE  TRACT.  23 

oesophagus. —  Beyond  there  are  no  racemose  glands   in    its 

walls  except  the  glands  of  Brunner  in  the  Duodenum. — 
Tubular  Glands  exist  from  the  eardia  to  the  anus. 

All  the  Muscular  Fibres  are  striped  down  to  the  middle  of 
the  oesophagus. — They  are  all  smooth  below  thai  point  down 
to  the  aims  exclusively. 

The  Submucous  Fibro-Areolar  layer  is  loose  from  the  lips 
to  the  anus,  except  over  the  gums  and  first  part  of  hard 
palate. 

The  Mucous  Membrane  presents  microscopic  papilla?  down 
to  the  eardia. 

The  Nerves  almost  all  take  support  on  the  arteries  to 
reach  the  organs. 

The  cutaneous  and  the  nmscnlar  layers  are  blended 
together. 

The  Muscle  is  an  orbicular  and  is  the  only  thoroughly 
cutaneous  muscle. 

The  Glandular  layer  is  submucous  and  is  thick. 

The  Mucous  layer  and  the  skin  come  in  contact. 

The  Epithelium  is  pavement. 

The  Arteries  strike  the  lips  at  the  commissures. —  They  are 
parallel  to  the  lips. — They  are  in  the  glandular  layer. 

The  Veins  of  the  upper  lip  open  into  the  facial,  which  in- 
oculates with  the  Ophthalmic. 

The  Lymphatics  of  the  middle  of  the  lower  lip  open  sep- 
arately in  the  digastric  glands. 
Peculiarities  of  the  Cheeks. 

There  is  a  small  adipose  mass  between  the  masseter  and 
the  buccinator  which  is  always  present. 

The  glandular  layer  is  represented  by  the  few  small  mo- 
lar glands  situated  around  the  part  where  Steno's  duct  per- 
forates the  buccinator. 

The  Buccinator  is  perforated  by  a  duct  (the  only  instance 
for  a  muscle). 

The  Submucous  layer  has  no  glands. 

The  Mucous  membrane  presents  the  orifice  of  Steno's 
duct  at  the  level  of  the  second  upper  molar  tooth. 

70  Peculiarities  of  the  Teeth. 

They  present  two  sets:  a  temporary  and  a  permanent  set. 
No  other  region  presents  this  feature  of  changement — The 
Wisdom  Tooth  comes  out  at  about  twenty. 

The  Enamel  corresponds  to  the  epidermis  of  the  skin — 
The  Cement  corresponds  to  the  bony  tissue. — The  Dentine 
corresponds  to  the  canalicules of  bones  and  of  the  cornea. 

The  Pidp  corresponds  to  the  hair  papilla. 
Peculiarities  of  the  Gums. 

The  Mucous  Membrane  is  remarkable  for  its  adhesion  to 
the  periosteum  (as  in  the  hard  palate). 

71  Peculiarities  of  the  Tongue. 

The  Prenum  presents  the  openings  of  Wharton's  Ducts. 
— The  Papillas  are  unique. — Papilla'  are  found  also  in  the 


24  PECULIARITIES  OF  THE  DIGESTIVE  TRACT. 

skin. — Microscopic  papillae  are  found  in  the  mucous  mem- 
brane of  the  lips  down  to  the  cardia. — They  resemble  the 
villi ;  but  these  differ  in  containing  in  their  interior  a  lym- 
phatic vessel. 

The  Ranine  Arteries  are  dangerously  large  beyond  the 
anterior  half 

The  Ranine  Veins  are  seen  by  transparency  through  the 
mucous  membrane. 

The  Capillaries  of  the  papillae  are  peculiar  and  character- 
istic :  they  are  poplar-like  in  the  conical  and  oak-like  in 
the  fungiform. 

The  Nerves  are  of  three  kinds : — The  Gustatory  is  the 
nerve  of  special  sense ;  it  comes  from  an  ordinary  nerve,  the 
inferior  maxillary,  a  unique  instance.  It  terminates  in  the 
taste-goblets. 

The  Grlosso-pharyngeal  supplies  ordinary  sensibility  to  the 
back  part  of  the  tongue  mostly. 

The  Hypoglossal  is  the  motor  nerve. 

The  tongue  is  the  only  muscle  which  presents  intrinsic 
fibres,  *'.  e.,  fibres  originating  and  terminating  in  it. 

72  Peculiarities  of  the  Hard  Palate. 

It  presents  the  mucous  papillae  and  the  transverse  ridges. 

The  Mucous  Membrane  is  closely  adherent  to  the  perios- 
teum in  front. — Behind  it  is  separated  by  a  thick  granular 
layer. 

The  Artery  is  in  the  groove  between  the  alveolar  process 
and  the  palatine  process. 
Peculiarities  of  the  Soft  Palate. 

It  is  a  single  flap  valve,  a  musculo-membranous  valve 
(unique  case). 

Its  floating  position  is  remarkable. 

Its  group  of  muscles  is  also  noticeable  :  elevators,  tensors, 
etc. 

It  has  a  double  layer  of  racemose  glands. 

The  epithelium,  situated  on  the  upper  surface,  is  ciliated. 

Its  nerves  come  from  a  ganglion  (Meckel's). 

73  Peculiarities  of  the  Tonsils. 

The  depressions  of  the  surface  are  noticeable. 

The  presence  of  the  tonsils  in  the  pharynx  is  remarkable. 

They  are  the  first  lymphoid  follicles  met  on  the  digestive 
tract. 

The  Deep  Surface  corresponds  to  the  Internal  Carotid 
Artery. 

It  receives  from   the   Pharyngeal    (external   carotid)    a 
tonsillar  branch  which,  in  chronic  inflammation,  becomes 
large  and  adherent  to  the  tissue,  hence  hemorrhage  when 
sectioned. 
Peculiarities  of  the  Parotid. 

It  is  the  largest  of  the  three  salivary  glands. 

Its  base,  expanded  on  the  cheek,  is  but  a  small  part  of  it. 

Its  body  is  deeply  seated  between  the  ear  and  the  jaw. 


PECULIARITIES  OF  THE  DIGESTIVE  TRACT.  17) 

It  extends  to  the  pharynx. 

It  is  in  relation  with  numerous  large  vessels,  nerves. — 
The  carotid,  temporal,  internal  maxillary,  behind  the  con- 
dyle.— The  Facial  nerve  crosses  the  outer  portion  of  it. — The 
Internal  Jugular,  Internal  Carotid,  the  Pneumo-gastric,  Hy- 
poglossal, Spinal  Accessory  correspond  to  its  posterior  sur- 
face near  the  apex. 

Its  Duct,  Steno's  Duct,  perforates  a  muscle,  the  buccin- 
ator (a  unique  case). —  It  has  thick  walls  and  a  small  bore. 
—  It  runs  parallel  to  the  zygoma,  but  one-quarter  inch 
below. 

74  Peculiarities  of  the  Submaxillary  Gland. 

It  is  outside  the  mouth. —  It  fills  the  digastric  triangle. — 
Its  posterior  extremity  is  crossed  by  the  facial  artery. 

Its  duct,  Wharton's  Duct,  is  inside  the  mouth. —  Its  walls 
are  thin  and  the  bore  large. — It  opens  by  a  twisted  papilla 
on  each  side  of  the  frenum. 

Its  nerves  come  from  the  chord  of  the  tympanum,  which, 
when  cut,  increases  the  secretion  of  the  gland. 
Peculiarities  of  the  Sublingual  Gland. 

It  is  inside  the  mouth,  whereas  the  other  salivary  glands 
are  on  the  outside. 

It  is  the  smallest  of  all  the  salivary  glands. 

It  raises  the  mucous  membrane  of  the  floor  of  the  mouth. 

It  is  mobile. 

It  has  several  separate  ducts,  the  Ducts  of  Rivinus  and 
the  Ducts  of  Bartholin. 

Nerves:  Same  as  for  submaxillary. 

75  Peculiarities  of  the  Pharynx. 

It  is  truly  the  beginning  of  the  intestinal  tract. 

Its  upper  portion  is  fixed  — the  middle  and  lower  portions 
are  movable. 

It  is  closed  above  and  behind  —  it  is  open  in  front  and 
below  —  it  communicates  with  the  ear,  the  nasal  cavities, 
the  mouth,  the  larynx,  the  oesophagus. 

It  is  at  the  same  time  part  of  the  respiratory  tract  and  of 
the  digestive  tract. 

Its  Lateral  Surfaces  are  in  relation  with  large  vessels  and 
nerves. 

It  presents  the  first  circular  and  longitudinal  fibres  —  it 
presents  the  last  fibres  with  bony  origin  or  insertion. 

It  presents  a  thick  layer  of  racemose  glands. 

The  Epithelium  of  the  upper  third  is  ciliated;  in  the 
other  portions  it  is  pavement. 

It  presents  a  thick  fibrous  layer. 

76  Peculiarities  of  the  OEsophagus. 

Its  length  is  remarkable,  extending  from  the  pharynx  to 
the  stomach,  because  of  the  heart  intervening  between  the 
pharynx  and  stomach. 

Its  shape  is  also  peculiar. 

Its  calibre  also;  it  is  narrowest  at  its  beginning,  is  narrow 


26  PECULIARITIES  OF  THE  DIGESTIVE  TRACT. 

also  opposite  the  fourth  dorsal  vertebra  and  is  slightly  con- 
stricted when  it  passes  through  the  diaphragm. 

Its  direction  is  peculiar  ;  at  its  origin  it  is  on  the  median 
line. — It  soon  deviates  to  the  left  side  at  the  root  of  the 
neck. — It  then  returns  to  the  median  line. —  It  finally  de- 
viates again  slightly  to  the  left  as  it  passes  through  the 
diaphragm. —  It  follows  also  the  curvatures  of  the  spinal 
column. 

Its  relations  are  numerous  and  important;  trachea, 
aorta,  carotids,  recurrent  laryngeal  nerve,  pericardium, 
thoracic  duct  and  pleura. —  The  pneumo-gastric  nerves  take 
support  on  it  to  reach  the  stomach. 

Its  lower  extremity  presents  no  line  of  demarcation  for 
the  stomach.  • 

Its  structure  is  peculiar  in  this,  that  the  muscular  fibres 
are  smooth  below  its  middle  portion. 

77  Peculiarities  of  the  Cavity  of  the  Abdomen. 

It  is  the  largest  of  all  the  cavities  of  the  body. 

Most  of  its  walls  are  soft  and  movable. 

Almost  all  of  the  largest  and  of  the  solid  organs  are  in 
the  upper  part. 

It  contains  a  great  number  of  various  organs,   whereas 
other  cavities  contain  but  few. 
Peculiarities  of  the  Peritoneum. 

It  is  the  largest  of  all  the  serous  cavities. 

It  presents'  a  smaller  cavity,  with  the  foramen  of  Winslow, 
which  no  other  presents. 

It  presents  a  great  number  of  folds  called  mesos. 

It  alone  presents  such  folds  as  the  Great  Omentum  and 
the  Mesentery. 

78  Peculiarities  of  the  Stomach. 

Its  size  varies  more  than  that  of  any  other  organ. 

Its  shape  is  peculiar  and  unique,  that  of  a  cone  bent  upon 
itself. 

The  situation  it  occupies  is  remarkable,  three  regions,  and 
it  extends  from  the  surface  to  the  deep  parts. 

It  presents  a  distinct  line  of  demarcation  between  it  and 
the  duodenum. 

It  presents  three  distinct  layers  of  muscular  fibres,  whereas 
the  other  organs  present  only  two. 

It  presents  the  peculiar  pyloric  valve,  a  sphincter  valve. 

The  mucous  membrane  presents  the  peculiar  hexagonal 
spaces  and  the  peculiar  peptic  glands. 

It  is  surrounded  by  a  circle  of  arteries. 

Its  veins  form  the  portal  system ;  also  all  the  veins  of  the 
intestines  and  the  spleen. 

Its  nerves  come  from  the  pneumo-gastric,  one  situated 
along  its  upper  border  and  the  other  on  the  posterior  sur- 
face. 

79  Peculiarities  of  the  Duodenum. 

Its  shape  is  peculiar,  that  of  an  irregular  crescent. 


PECULIARITIES  OF  THE  DIGESTIVE  TRACT.  li  t 

Its  fixity  is  noticeable,  whereas  the  small  intestines  are 
very  movable. 

It  deep  situation  is  peculiar,  for  all  the  small  intestines 
are  superficial. 

It  is  deprived  of  a  line  of  demarcation  from  the  jejunum. 

It  is  the  thickest  and  the  largest  portion  of  all  the  small 
intestines. 

It  presents  the  Large  Papilla  containing  the  openings  of 
two  large  ducts,  the  Common  Bile  Duct,  and  the  Pancreatic. 

It  presents  also  the  Small  Papilla  corresponding  to  the 
Lesser  Pancreatic  Duct. 

It  presents  Valvulae  Oonniventes  found  nowhere  else  ex- 
cept in  the  small  intestines. 

It  presents  Villi  which  are  not  found  outside  of  the  small 
intestines. — Its  Villi  are  crest-like. — Their  capillaries  are 
under  the  epithelium,  in  the  stroma. — A  Villus  is  charac- 
terized by  having  a  dilated  lacteal  in  its  centre. 

It  has  peculiar  racemose  glands,  the  Glands  of  B runner. 
80     Peculiarities  of  the  Jejunum. 

The  mobility  of  its  coils  is  remarkable. 

It  is  superficially  situated. 
'  It  occupies  the  umbilical  and  the  two  lumbar  regions. 

It  presents  no  line  of  demarcation  from  the  duodenum 
or  from  the  ileum. 

Its  Valvulas  Conniventes  are  more  numerous. — The  Villi 
are  conical. — It  presents  scattered  Isolated  Closed  Follicles. 
These  are  henceforth  found  down  to  the  anus. 

It  receives  its  arterial  supply  from  one  source  alone — the 
Superior  Mesenteric,  as  also  the  ileum. 

The  lymphatics  are  called  the  lacteals,  down  to  the  anus. 

Its  Nerves  come  from  the  sympathetic  and  reach  it  by 
taking  support  on  the  arteries. — The  same  applies  to  the 
rest  of  the  intestines,  small  and  large. 
Peculiarities  of  the  Ileum. 

It  occupies  the  lower  part  of  the  abdomen. — It  dips  down 
into  the  pelvis. — It  usually  leaves  the  caecum  and  the  sig- 
moid flexure  uncovered. — It  also  is  superficially  situated. 

The  mobility  of  its  coils  is  also  great. 

It  presents  no  line  of  demarcation  from  the  jejunum. 

It  is  separated  from  the  larger  intestines  by  the  ileo-caacal 
valve. 

Its  walls  are  thinner  than  at  any  other  point  of  the  small 
intestines. 

The  Valvules  are  smaller,  fewer  and  further  apart. 

The  Villi  are  also  less  numerous. 

The  Isolated  Closed  Follicles  are  more  numerous. 

It  alone  presents  the  peculiar  Fever's  patches. — These 
patches  are  all  situated  on  the  convex  border  of  the  small  in- 
testines.— They  are  larger  and  more  numerous  as  we  come 
nearer  the  ileo-caval  valve. 


28  PECULIARITIES  OF  THE  DIGESTIVE  TRACT. 

81  Peculiarities  of  the  IIeo=caecal  Valve. 

It  is  a  double-flap  muco-membranous  valve.  (In  the 
heart  the  double-flap  valves  are  purely  fibrous.) — It  contains 
few  smooth  muscular  fibres. 

It  opens  readily  to   fluids  coming  from  the  ileum,  but 
closes  against  fluids  coming  from  the  large  intestines. 
Peculiarities  of  the  Cascal  Appendix. 

It  is  unique. — Abnormally  we  sometimes  find  similar 
diverticles  on  the  course  of  the  intestines. 

Its  situation  is  noticeable,  behind  the  ileo-csecal  valve. 

It  is  often  twisted. 

Its  caecal  extremity  is  closed  by  the  effective  valve  of 
Morgagni. 

It  often  contains  seeds  and  foreign  bodies. — It  is  the  in- 
itial point  of  appendicitis. 

Its  walls  are  thick. — The  muscular  fibres  are  uniformly 
distributed  around  it. — It  possesses  only  tubular  glands. 

82  Peculiarities  of  the  Caecum. 

Its  dimensions  are  short. 

Its  shape  is  noticeable ;  it  is  cuboidal  and  is  sacculated,  as 
is  the  balance  of  the  large  intestines  down  to  the  rectum. 

It  is  usually  superficially  seated. 

It  receives  the  opening  of  the  caacal  appendix  and  the  ileo- 
cecal valve. 

Its  walls  are  thin. 

The  longitudinal  muscular  fibres  are  arranged  in  bandel- 
ettes. 

The  mucous  layer  presents  ridges  and  saccules. 

It  possesses  only  tubular  glands  and  isolated  follicles. 

It  receives  its  arterial  supply  from  the  Superior  Mesen- 
teric. 
Peculiarities  of  the  Ascending  Colon. 

Is  deeply  seated,  behind  the  coils  of  the  jejunum. 

It  is  fixed  in  its  position. 

The  Posterior  Surface  is  deprived  of  peritoneum. 

It  is  in  relation  in  front  with  the  liver  and  the  right  kid- 
ney. 

It  presents  a  separation  from  the  caecum,  the  ileo-ceecal 
valve. 

It  is  separated  from  the  transverse  colon  by  an  angle. 
Peculiarities  of  the  Transverse  Colon. 

It  is  superficially  seated. 

It  corresponds  to  the  line  between  the  epigastrium  and 
the  umbilical  region. 

It  is  very  movable,  possessing  a  long  fold  of  the  perito- 
neum, the  transverse  meso-colon. 

It  is  in  relation  with  the  liver,  stomach,  pancreas,  spleen, 
small  intestines. 

It  presents  the  right  and  the  left  bends. 

The  right  half  is  supplied  by  the  Superior  Mesenteric  ar- 
tery and  the  left  by  the  Inferior  Mesenteric. 


PECULIARITIES  OF  THE  DIGESTIVE  TRACT.  li«» 

Peculiarities  of  the  Descending  Colon. 

It  is  deeply  seated,  behind  the  coils  of  the  jejunum. 
It  is  fixed  in  its  position. 

The  Posterior  Surface  is  deprived  of  peritoneum. 
It  is  in  relation  with  the  spleen  and  left  kidney. 
It  presents  no  separation  from  the  sigmoid  flexure. 

83  Peculiarities  of  the  Sigmoid  Flexure. 

It  is  superficially  seated,  usually  uncovered  by  the  coils 
of  the  ileum. —  It  is  movable. —  Sometimes  it  is  found  in 
the  pelvis. 

Its  shape  is  peculiar,  that  of  an  italic  8. 

It  presents  no  line  separating  it  from  the  colon  and 
rectum. 

The  mucous  membrane  presents  only  tubular  glands  and 
closed  follicles. 
Peculiarities  of  the  Rectum. 

Is  so  called  because  it  is  more  straight  than  the  coils  of 
the  smaller  intestines. 

It  is  sometimes  very  large. 

It  presents  a  lateral  curve  and  an  anterior  one. 

It  is  deeply  seated. 

The  upper  third  is  completely  surrounded  by  perito- 
neum.—  The  middle  third  only  in  front  and  on  the  sides. — 
The  lower  third  not  at  all. 

It  is  in  relation  with  the  bladder,  prostate,  seminal  vessels, 
spermatic  ducts,  ureters  ; — in  the  female  with  the  uterus 
and  vagina. 

It  presents  no  line  of  separation  from  the  sigmoid  flexure. 

It  is  separated  from  the  anus  by  the  strong  edge  of  the 
sphincter  and  by  a  change  of  direction. 

The  muscular  fibres  are  stronger  than  anywhere  else.  — 
They  are  uniformly  distributed  all  around. —  The  circular 
fibres  form  the  Internal  Sphincter  (like  the  pyloric  valve). 

The  Submucous  layer, is  very  thick. 

The  Mucous  membrane  is  thicker. 

The  Tubular  Glands  and  the  Isolated  Closed  Follicles  arc 
more  numerous. 

The  Arteries  are  the  three  hemorrhoidals ;  the  superior 
are  the  most  important. 

The  nerves  come  from  the  hypogastric  plexus. 

84  Peculiarities  of  the  Anus. 

Its  height,  one  inch,  is  remarkable. 

Its  shape,  a  ring,  is  noticeable. 

The  relations  of  the  lateral  surfaces  with  the  adipose  tis- 
sue of  the  ischio-rectal  fossa'  is  important  surgically. 

It  is  separated  from  the  rectum  by  the  strong  edge  of  the 
sphincter  muscle. 

The  lower  extremity  is  continuous  with  the  skin,  the  sec- 
ond instance  of  a  mucous  membrane  continuous  with  a  cu- 
taneous membrane. 


30'  PECULIARITIES  OF  THE  DIGESTIVE  TRACT. 

The  attachment  of  the  sphincter  to  the  coccyx  and  to  the 
perineal  muscles  are  important  surgically. 

The  Muco-cutaneous  layer  presents  peculiar  pouches  and 
pillars. — It  presents  tubular  glands  on  the  mucous  portion. 
— It  presents  sebaceous  glands  on  the  cutaneous  portion. 

The  Veins  are  the  farthest  radicles  of  the  portal  system. 

The  Lymphatics  of  the  mucous  portion  open  in  the  pelvic 
glands. — Those  of  the  cutaneous  portion  in  the  inner  in- 
guinal glands. 

The  Nerves  are  numerous  and  very  sensitive :  these  re- 
flexes are  the  last  abolished  in  anesthesia. 

85     Peculiarities  and  Characteristics  of  the  flucous  riem= 
brane  Alone  of  the  Digestive  Tract. 
Guide:  Mention  first  peculiarities  (projections  or  depres- 
sions), then  peculiarities  of  epithelium  and  glands,  if  any. 
Epithelium. 

It  is  stratified  or  laminated,  i.  e.,  is  in  many  layers 
throughout  the  whole  length. 

It  is  pavement  from  the  lips  down  to  the  cardia  (except 
in  the  nasal  portion  of  the  pharynx,  where  it  is  ciliated). 

It  is  columnar  from  the  cardia,  down  to  the  anus. 
Microscopic  Papillae,  similar  to  those  of  the  skin,  exist 
from  the  lips  to  the  cardia. 

Glands  :  All  the  glands  are  Racemose  from  the  lips  to  the 
cardia. 

All  the  glands  are  Tubular  from  the  cardia  to  the  anus 
(except  the  Brunner  Racemose  Glands  of  the  duodenum). 
Lips :  The  glands  form  a  thick  submucous  layer. 
Cheeks:  Present  the  opening  of  Steno's  Duct,  opposite  the 
upper  second  molar. 

The  Glands  are  the  peculiar  Molar  Glands  and  the  open- 
ing of  Steno's  Duct,  on  the  outer  surface  of  the  buccinator. 
—  There  is  no  submucous  layer  of  glands. 
Gums :  The  mucous  membrane"  adheres  closely  to  the  peri- 
osteum. 

They  have  no  glands. 
Tongue:  It  presents  on  the  Dorsal  aspect  the  Papillae. 

Glands  do  not  exist  where  the  papilla?  are ;  they  exist 
only  on  the  posterior  third. 

On  the  Under  Surface  the  mucous  membrane  shows  the 
ranine  veins.  . 

Also  the  opening  of  the  Ducts  of  Wharton,  of  Rivinus, 
of  Bartholin.  • 

Hard  Palate  :  It  presents  the  Incisor  Papilla. — Also  trans- 
verse ridges. 

It  adheres  to  the  periosteum  in  front  but  is  loose  behind. 
Soft  Palate :  The  Epithelium  is  situated  on  the  upper  sur- 
face. 

The  Glands  form  a  double  layer. 


LIVER.  '.'A 

Tonsils:  They  present  depressions  or  pouches. 

The  proper  element  of  the  tonsils  arc  closed   Lymphoid 
follicles. 

Pharynx:  The  glands  are  large  and  prominent. 
(Esophagus:    Presents  nothing   characteristic,   except    the 
very  absence  of  characteristics. 
86     Stomach:  It  presents  the  hexagonal  spaces. 

It  presents  the  peculiar  Cardiac  Tubular  Peptic  Glands. 
Duodenum  :  Presents  the  Large  and  the  Small  Papillae. 

Also  the  Valvula?  Conniventes. 

Also  the  Villi,  which  are  crest-like. —  The  Villi  are  char- 
acterized by  a  central  lacteal  vessel. 

It  presents  also  the  peculiar  Racemose  Glands  of  Brun- 
ner. 
Jejunum:  The  Valvula?   Conniventes  are  more  numerous. 

The  Villi  are  conical. 

It  presents  few  Isolated  Closed  Follicles. —  These  follicles 
extend  from  this  point  to  the  anus. 

Ileum  :  The  Valvules  Conniventes  are  fewer  and  further  be- 
tween and  are  very  scarce  and  small  near  the  ileo-c^cal 
valve. 

The  Isolated  Follicles  are  more  numerous. 

Here  we  find  the  Peyer's  Patches  described  above. 
Caeca  1  Appendix:  Presents  no  closed  follicles. 
Caecum,  Colons,  Sigmoid   Flexure  :    They  present  crests 
and  saccules. 

Isolated  follicles  are  not  very  numerous. 
Rectum  :  The  membrane  is  thick. 

The  glands  are  numerous. 

The  submucous  areolar  tissue  is  abundant  and  binds  the 
membrane  loosely  to  the  muscular  coat. 

Anus:  The  membrane  is  thick. —  It  presents  the  pouches 
and  pillars. 

The  Glands  on  the  cutaneous  portion  are  sebaceous. 

LIVER. 

87     Shape.     The  liver  resembles  the  half  of  an  ovoid. 

The  Upper  Surface  is  convex; — it  gives  attachment  to  the 
suspensory  ligament; — it  is  in  relation  with  the  diaphragm 
and  the  abdominal  walls. 

The  Upper  or  Posterior  Border  presents  a  notch  for  the 
ascending  cava  vein  ; — it  gives  attachment  to  the  coronary 
and  lateral  ligaments  ; — it  is  in  relation  with  the  aponeu- 
rotic diaphragm. 

The  Lower  or  Anterior  Border  is  thin: — it  present-  ;i 
notch  for  the  round  ligament  and  one  for  the  gall  bladder; 
it  is  in  relation  with  the  edge  of  the  costal  cartilages  and 
the  abdominal  walls. 


32  PANCREAS. 

88     The  Right  Extremity  is  thick — and  is  in  relation  with  the 
diaphragm  and  kidney. 

The  Left  Extremity  is  thin — and  is  in  relation  with  the 
spleen. 

The  Under  Surface  is  concave. 

The  Middle  Region  presents :  1st,  the  transverse  fissure 
lodging  the  gastro -hepatic  omentum,  the  hepatic  artery, 
portal  vein,  left  pnenmo-gastric  nerve,  the  hepatic  ducts, 
lymphatic  vessels  and  glands  ; —  2d,  the  fissure  for  the  round 
ligament; — 3d,  the  fissure  for  the  ascending  cava  vein; — 
4th,  the  fissure  for  the  ductus  venosus; — 5th,  the  fossa 
for  the  gall  bladder; — 6th,  the  Spigelian  and  caudate  lobes, 
corresponding  to  the  upper  border  of  the  stomach ; — 7th, 
square  lobe. 

The  Right  Region  is   in   relation  with   the   angle  of  the 
colon,  the  right  supra-renal  capsule  and  kidney. 

The  Left  Region  is  in  relation  with  the  left  extremity  of 
the  stomach  and  spleen. 

89.  Structure.  1st:  The  liver  has  Two  Envelopes, —  a  Serous 
or  Peritoneal  endothelial  layer — and  a  Fibrous  Layer  re- 
flected at.  the  hilus  into  the  interior  of  the  organ  and  called 
the  Capsule  of  Glisson; —  2d,  the  Proper  Tissue  is  composed 
of  alveoles  filled  with  the  proper  hepatic  cells  and  forming 
the  hepatic  lobules; — 3d,  the  Portal  Vein  and  the  Hepatic 
Artery  form  a  plexus  around  each  lobule  and  send  into  the 
interior  of  the  lobule  separate  branches  which  become  the 
radicles  of  the  Capillary  Hepatic  Vein  or  Intralobular  Vein, 
which  occupies  the  centre  of  the  lobule  ; — the  trunks  of  the 
hepatic  veins  open  into  the  ascending  cava  along  the  upper 
border  of  the  liver; — 4th,  the  Capillary  Bile  Radicles  origi- 
nate in  the  lobules  by  dilated  extremities,  which  according 
to  some  are  surrounded  by  hepatic  cells,  whereas,  according 
to  the  author,  they  are  lined  by  the  hepatic  cells. 
Excretory  Apparatus  of  the  Liver.  The  capillary  bile 
radicles  unite  to  form  the  Bile  Ducts  which  unite  in  the 
transverse  fissure  to  form  the  Hepatic  Duct.  This  duct  re- 
ceives the  Cystic  Duct  from  a  reservoir  called  the  Gall 
bladder  and  the  two  form  the  Common  Bile  Duct. — This 
descends  into  the  groove  between  the  duodenum  and  pan- 
creas where  it  is  joined  by  the  main  pancreatic  duct  and 
opens  into  the  duodenum  at  the  apex  of  the  Large  Papilla. — 
Structure.  The  large  ducts  and  the  gall  bladder  are  com- 
posed of  an  external  fibrous  coat,  of  a  middle  fibro-elastic 
and  muscular  coat  and  of  an  internal  mucous  coat. — They 
present  in  their  walls  a  large  number  of  microscopic  racemose 
glands. 

PANCREAS. 

90  Shape.  The  pancreas  resembles  a  hammer  with  its  handle. 
The  Anterior  Surface  presents  grooves  and  lobules  and  so 
do  the  other  surfaces ; — it  is  in  relation  with  the  stomach. 


SPLEEN.  33 

The  Upper  Border  is  grooved  for  the  splenic  vein;  the 
splenic  artery  is  above  the  vein. 

The  Lower  Border  presents  a  notch  for  the  superior  mesen- 
teric artery. 

The  Right  Extremity  or  Head  is  separated  from  the  body 
by  a  neck; — it  is  embraced  by  the  duodenum. 
The  Left  Extremity  or  Tail  is  in  relation  with  the  spleen. 
The  Posterior  Surface  is  in  relation  with  the  aorta  and  the 
pillars  of  the  diaphragm,  the  ascending  cava  vein  and  the 
vertebral  column. 

91  Structure.  The  pancreas  is  a  compound  racemose  gland. 
The  Main  Burt  or  Duct  of  Wirsung  comes  from  the  body, 
joins  the  common  bile  duct  and  opens  into  the  dnodennm. 
The  Lesser  Duct  comes  from  the  head  and  opens  often  sep- 
arately into  the  duodenum  above  the  main  duct,  at  the  apex 
of  the'  Small  Papilla. 

SPLEEN. 

92  Shape.     The  Spleen  is  oblong  and  flattened. 

The  External  Surface  is  convex ; — it  is  in  relation  with  the 
diaphragm  and  ribs. 

The  Internal  Surface  presents  in  the  middle  a  ridge  with 
orifices  for  the  bloodvessels  and  called  the  Mlum; — the  sur- 
face in  front  is  in  relation  with  the  stomach ; — the  surface 
behind  is  in  relation  with  the  tail  of  the  pancreas  and  the 
left  supra-renal  capsule. 

The  Anterior  and  Posterior  Borders  are  convex  and  some- 
times notched. 

The  Upper  Extremity  is  thick; — it  gives  attachment  to 
the  spleno-phrenic  omentum,  or  "suspensory  ligament :  " — 
it  is  in  relation  with  the  diaphragm. 

The  Lower  Extremity  is  pointed; — it  gives  attaehment  to 
the  spleno-colic  omentum; — it  is  in  relation  with  the  angle 
of  the  colon. 

93  Structure.  1st,  The  spleen  has  an  External  or  Peritoneal 
endothelial  coat, — and  a  thick  Fibro-muscular  coat  reflected  a1 
the  hilum  into  the  organ  and  forming  sheaths  for  the  ves- 
sels ; — 2d,  The  Proper  Tissue  of  the  spleen  is  composed  of 
alveoles  containing  the  splenic  pulp  composed  of  splenic 
corpuscles,  lymphoid  cells,  pigment  grannies,  red  blood 
corpuscles  (normal  and  distorted),  cells  containing  blood 
corpuscles  entire  or  in  fragments,  and  cells  containing  pig- 
ment;—3d,  The  Arterial  Capillaries  open  into  the  alveoles 
as  in  the  erectile  tissues  aud  as  the  lymphatic  capillaries  do 
in  the  lymphatic  glands;— 4th.  The  Venous  Capillaries  orig- 
inate by  dilated  orifices  on  the  inner  walls  of  the  alveoles  ;— 
the  splenic  vein  is  one  of  the  large  formative  veins  of  tin- 
portal  system. 

3 


34  SPLEEN. 

94     Peculiarities  of  the  Liver. 

It  is  the  heaviest  organ  in  the  body. 

It  is  the  largest  solid  organ  of  the  body. 

Its  color  is  peculiar  brown  (like  the  kidneys). 

It  occupies  three  regions,  the  right  hypochondrium,  the 
epigastrium  and  the  left  hypochondrium. 

Its  shape  is  peculiar  and  unique,  resembles  the  half  of  an 
ovoid. 

The  Upper  Border :  Is  adherent  to  the  aponeurotic  dia- 
phragm.—  It  presents  the  notch  for  the  Inferior  Cava 
Vein. —  It  presents  the  Large  Hepatic  Veins  opening  into 
this  Cava. 

The  Lower  Border  :  Presents  a  notch  for  the  peculiar  Gall 
bladder. —  Also  for  the  peculiar  Round  Ligament. —  It  does 
not  descend  below  the  chondral  border. 
The  Under  Surface  :  Is  peculiar  in  presenting  five  grooves 
or  fissures  in  which  are  centered  about  all  the  important 
features  of  the  organ. —  Also  by  presenting  three  separate 
lobes,  the  Spigelian,  the  Square,  the  Caudate. 
The  Relations :  Are  remarkable  and  important :  dia- 
phragm and  pleura,  stomach,  duodenum,  small  intestines, 
colons,  supra-renal  capsule,  kidney,  inferior  cava. 

It  is  a  friable  organ. 

The  Reflection  of  the  Fibrous  Coat  into  the  interior  of 
the  organ- (Capsule  of  Glisson)  is  nowhere  so  well  marked. 

The  Radiated  arrangement  of  the  Hepatic  Cells  in  the 
lobules  is  unique. 

The  Double  Peri-lobular  plexuses,  i.  e.,  formed  by  the 
Portal  Vein  and  the  Hepatic  Artery,  is  unique. 

The  origin  of  the  Central  Intra-lobular  Hepatic  Veins  is 
unique. 

The  Exit  of  the  Hepatic  Veins  at  a  point  distant  from  the 
other  vessels  is  most  rare. 

The  adhesion  of  the  walls  of  the  hepatic  veins  to  the  he- 
patic tissue  is  unique. 

The  origin  of  the  bile  radicles  by  a  dilatation  surrounded 
by  cells,  if  admitted,  is  unique. 

The  Excretory  Apparatus  is  the  most  extensive  and  com- 
plicated. 

The  presence  of  a  reservoir,  the  gall  bladder,  is  rare  (like 
the  seminal  vesicles  and  the  bladder). 

The  Walls  of  the  Gall  Bladder  possess  a  distinct  muscu- 
lar coat. —  Its  mucous  membrane  is  reticulated,  like  the 
urinary  bladder. 

The  Cystic  Duct  is  twisted,  like  Wharton's  Duct  and  sweat 
glands. 

The  course  of  the  Common  Bile  Duct  along  with  the  Pan- 
creatic Duct  is  unique. 

The  presence  of  the  Large  Papilla  is  rare  (like  the  small 
pancreatic  duct,  Wharton's  duct). 


SPLEEN.  35 

The  Walls  of  the  ducts  have   a   distinct    muscular  coal 

(unique). 

The  walls  also  have  microscopical  racemose  glands  (a 
unique  case). 

The  Hepatic  Artery  is  remarkably  small  for  the  organ. 

The  Portal  Vein  System  is  unique  in  size ;  (the  other  in- 
stance is  in  the  glomerule  of  the  kidney). —  Here  is  the 
only  instance  where  a  vein  penetrates  into  an  organ  like  an 
artery,  and  is  distributed  through  the  organ  after  the  fash- 
ion of  an  artery. 

It  has  no  valves. 

The  Hepatic  Veins  do  not  follow  the  arteries,  a  unique 
case  (except  the  veins  of  the  brain). 

They  have  no  valves. 

The  nerves  come  direct  from  the  left  pneumo-gastric  in- 
directly from  the  solar  plexus  ;  there  they  take  support  on  the 
hepatic  artery. 

95  Peculiarities  of  the  Pancreas. 

It  is  the  largest  racemose  gland. 

Its  situation  remarkable ;  it  is  deeply  seated,  across  the 
vertebral  column. 

Its  shape  is  peculiar ;  a  dog's  tongue,  a  hammer. —  The 
presence  of  a  head,  neck  and  tail  is  peculiar. 

The  Surfaces  are  more  distinctly  grooved  and  lobulated 
than  any  other  gland. —  The  Upper  Border  presents  a 
groove  for  the  splenic  vein,  a  unique  case. —  The  artery  is  on 
top  of  the  vein. 

Its  Relations  are  numerous  and  important :  duodenum, 
spleen,  supra-renal  capsule,  aorta,  inferior  cava,  portal 
vein,  thoracic  duct. 

It  presents  two  distinct  large  visible  ducts,  a  unique  in- 
stance.— The  openings  of  the  ducts  present  prominent  pa- 
pilla? (like  the  duct  of  Wharton). 

It  possesses  one  single  large  artery, —  which  is  on  top  of 
the  vein. 

The  veins  form  the  portal  system . 

96  Peculiarities  of  the  Spleen. 

Its  color  is  peculiar  :    a  slate  color. 

Its  size  varies  more  than  that  of  any  other  organ. 

It  is  deeply  seated  in  the  left  hypochondrium. 

Its  shape  is  peculiar;   prismatic. 

The  Inner  Surface  presents  a  ridge  upon  which  is  Located 
the  hilum. —  Everywhere  else  the  hilum  is  in  a  depression. 
(transverse  fissure  of  liver,  kidneys,  lungs,  ovaries, 
lymphatic  glands). 

The  Borders  are  sometimes  notched. 

The  Larger  Extremity  is  turned  upward  (like  the 
kidney). 

It  is  very  friable  (like  liver,  kidney,  brain). 

The  Subperitoneal  Coat  contains  muscular  fibres  in  abun- 
dance, a  unique  case. 


36  URINARY  ORGANS — SUPRA-RENAL  CAPSULES — KIDNEYS. 

The  Walls  of  the  Microscopic  Alveoles  are  formed  of  the 
peculiar  adenoid  tissue. 

The  contents  of  the  microscopic  alveoles  are  peculiar  in 
number :  cells  containing  blood  corpuscles,  entire  or  in 
fragments ;  cells  containing  pigment,  red  blood  corpuscles 
normal  and  distorted,  the  pigment  granules,  the  corpuscles 
(which  are  very  different  from  those  of  the  kidneys) — 
Also  lymphoid  cells ;  but  these  are  found  in  all  the  other 
lymphoid  organs  (tonsils,  isolated  follicles,  Peyer's 
Patches,  supra-renal  capsules,  thyroid  body,  thymus,  pitu- 
itary body). 

The  Artery  is  remarkable  for  its  size  compared  to  the 
organ. — It  terminates  into  the  microscopic  alveoles  by  free 
extremities. 

The  Intermediate  Capillaries  or  Capillaries  Proper  are  re- 
placed by  the  microscopic  alveoles. 

The  Venous  Capillaries  originate  by  dilated  free  extrem- 
ities. 

The  Splenic  Vein  is  unusually  large. — It  forms  the  Portal 
Vein. — It  has  no  valves. 

The  Lymphatics  originate  from  the  peculiar  lymph 
spaces  in  the  adenoid  tissue. 

The  Nerves  take  support  on  the  artery  as  in  almost  all  the 
viscera. 

URINARY  ORGANS. 

97  Enumeration.  The  urinary  organs  comprise  the  supra- 
renal capsules,  the  kidneys,  calices,  pelvis,  ureters,  bladder, 
prostate  and  urethra. 

SUPRA-RENAL  CAPSULES. 

98  Shape.  The  supra-renal  capsules  are  flattened  and  trian- 
gular, and  resemble  a  liberty  cap. 

The  Anterior  Surface  is  in  relation  with  the  liver  on  the 

right  and  the  spleen  on  the  left  side. 

The  Outer  Border  is  convex. 

The  Lower  Border  or  base  caps  the. kidney. 

The  Inner  Border  receives  the  vessels. 

The  Apex  presents  nothing  special. 

The  Posterior  Surface  is  in  relation  with  the  diaphragm. 

Structure.     The  supra-renal  capsules  are  composed: — 1st, 

of  an  External  or  Fibrous  coat; — 2d,  of  the  Proper  Tissue, 

which  is  composed  of  a  cortical  or  yellow  portion  and  of  a 

medullary  or  gray  portion. — Both  substances  are  composed 

of  alveoles  containing  lymphoid  cells. 

KIDNEYS. 

99  Shape.  The  kidneys  are  flattened,  oval  bodies;  they  re- 
semble a  bean. 

The  Anterior  Surface  is  convex;  it  is  in  relation  with  the 


('ALICES — PELVIS.  :}7 

ascending  colon  and  liver  on  the  right  and  the  descending 

colon  and  spleen  on  the  left  side 

The   Internal    Border  presents  a   notch    called    the    Mlum, 

where  the  renal  artery  and  the  nervous  filaments  penetrate 

the  organ  and  where  the  veins,  lymphatic;  vessels  and  the 

pelvis  come  out  of  it. 

The  External   Border  is  convex; — it  rests  on  the  square 

lumbar  muscle. 

The  Upper  Extremity  is  thick; — it  is  in  relation  with  the 

supra-renal  capsule. 

The  Lower  Extremity  is  thin  and  is  about  two  inches  from 

the  crest  of  the  ileum. 

The  Posterior  Surface  is  almost  flat; — it  is  in  relation  with 

the  pillars  of  the  diaphragm,  the  psoas  muscle,  the  square 

lumbar  muscle  and  the  vertebral  column. 

100  Structure.  The  kidneys  are  composed: — 1st,  of  a  Cellulo- 
adipose  capsule  ; — 2d,  of  a  Fibrous  Coat  reflected  at  the  hilum 
into  the  organ  ; — 3d,  its  Proper  Tissue  is  composed  of  an  ex- 
ternal cortical  or  granular  substance  and  of  an  internal  or 
medullary  or  pyramidal  substance. — Both  substances  are 
composed  of  the  Uriniferous  Canalicules,  which  are  straight 
in  the  medullary  substance,  but  very  much  convoluted  in 
the  cortical  portion, —  where  they  terminate  by  a  dilatation 
called  the  Capsule  of  Malpighi,  containing  a  tuft  of  convo- 
luted capillaries  called  the  Glamerule, — the  whole  forms  the 
Corpuscle  of  Malpighi. 

C  ALICES. 

101  Shape.     The  calices  are  cylindrical  and  funnel-shaped. 
The  Anterior  Surface  is  in  relation  with  the  renal  artery 
and  vein. 

The  Outer  Extremity  is  attached  around  the  apex  of  the 

corresponding  pyramid  of  Malpighi. 

The  Inner  Extremity  is  attached  to  the  pelvis. 

The  Posterior  Surface  is  in  relation  with  the  adipose  capsule. 

Structure.     They  are    composed: — 1st.  of  an  External  or 

Fibrous  Coat,  and  —  2d,  of  an  Internal  or  Mucous  Coat. 

PELVIS. 

102  Shape.     The  pelvis  is  a  funnel-like  pouch. 

The  Anterior  Surface  is  in  relation  with  the  renal  artery 

and  vein. 

The  Upper  Border  is  convex. 

The  Lower  Border  is  concave. 

The  Base  receives  the  calices. 

The  Apex  is  continuous  with  the  ureter. 

The    Posterior    Surface    is    in    relation    with    the    cellulo- 

adipose  capsule  and  the  psoas  muscle. 

Structure.     The  Pelvis  is   composed: — 1st.  of  a   Fibrous 

Coat,  slightly  elastic  and  muscular; — 2d.  of  a  Mu<<>ks  Coa /. 


38  URETER — BLADDER. 

URETER. 

103  Direction  and  Course.  The  ureter  descends  obliquely  in- 
wards along  the  psoas  muscle, —  enters  the  pelvic  cavity, — 
crossing  the  angle  of  bifurcation,  of  the  iliac  vessels  —  and, 
curving  forwards  and  inwards  in  the  vesical  fold  of  the 
peritoneum, —  reaches  the  fundus  of  the  bladder. 

Shape.  The  ureter  has  the  shape  of  a  long,  narrow  and 
thin  tube. 

The  Anterior  Surface  is  in  relation  with  the  peritoneum 
and  base  of  bladder. 

The  Upper  Extremity  is  continuous  with  the  pelvis. 
The  Lower  Extremity  opens  into  the  bladder — in  a  valve- 
like manner. 

The  Posterior  Surface  is  in  relation  with  the  psoas, —  then 
the  angle  of  bifurcation  of  the  iliac  vessels, —  then  the  pelvic 
areolar  tissue,  the  rectum,  the  spermatic  duct  and  the  semi- 
nal vesicles. 

Structure.  The  ureter  is  composed: — 1st,  of  an  External 
Fibrous  and  slightly  elastic  and  muscular  layer ; — 2d,  of  a 
thin  Mucous  Coat. 

BLADDER. 

104  Shape.     The  bladder  when  distended  is  ovoidal. 

The  Anterior  Surface  is  deprived  of  peritoneum  except 
sometimes  near  the  apex; — it  is  in  relation  with  the  pubis. 
The  Posterior  Surface  is  covered  by  peritoneum; — it  is  in 
relation  with  the  upper  part  of  the  rectum. 
The  Lateral  Surfaces  are  covered  by  peritoneum  only  in 
their  upper  and  back  part. 

The  Apex  gives  attachment  to  the  urachus. 
The  Base  of  Fundus  is  in  relation  with  the  prostate  in 
front  and  the  rectum  behind  ; —  on  the  sides  it  is  in  relation 
with  the  seminal  vesicles,  the  spermatic  ducts  and  ureters. 
The  Neck  of  the  Bladder  is  situated  in  advance  of  the 
fundus, —  is  funnel-like, —  is  in  relation  with  the  anterior 
and  lateral  ligaments  of  the  bladder. 

105  Structure.  The  bladder  is  composed : — 1st,  of  a  Peritoneal 
Coat  which  covers  only  its  posterior  surface  and  the  upper 
back  part  of  the  lateral  surfaces ; — 2d,  of  a  layer  of  Longi- 
tudinal Muscular  Fibres  originating  from  the  pubis  and  pros- 
tate below  and  above  from  the  urachus ; —  3d,  of  a  Layer  of 
Circular  Fibres  which  thicken  and  form  the  Sphincter; — 4th, 
of  a  Layer  of  Plexiform  Fibres; — 5th,  of  a  Mucous  Coat  which 
presents  at  the  back  a  depressed  portion  called  the  Bas-fond, 
and  in  front  a  triangular  space  called  the  Trigone,  the  angles 
of  which  are  formed  by  the  urethra  and  the  two  ureters. 


PROSTATE.  39 


PROSTATE. 

106  Shape.     The  prostate  is  triangular. 

The    Lateral    Surfaces    are   in   relation    with    the    pelvic 

areolar  tissue. 

The  Under  Surface  presents  sometimes  a  middle  Lobe  and 

two  lateral  lobes  : — it  is  in  relation  with  the  rectum. 

The  Base  is  directed  backwards  —  it  is  in  relation  with  the 

apices  of  the  seminal  vesicles  and  the  ejaculatory  ducts. 

The  Apex  is  directed  forwards  —  it  is  in  contact  with  the 

membranous  portion  of  the  urethra. 

The  Upper  Surface  forms  the  floor  of  the  prostatic  portion 

of  the  urethra  —  it  presents  the  urethral  crest,  the  utricle. 

the  openings  of  the  ejaculatory  ducts  and  of  the  ducts  of 

the  prostate  itself. 

Structure.     The  prostate  is  composed, —  1st,  of  an  External 

or  Fibrous  Coat; — 2d,   of  a  Proper  Substance  composed  of 

smooth   muscular   fibres   and  of   simple   racemose  glands. 

which  open  into  the  prostatic  urethra. 

107  Peculiarities  of  the  Supra=Renal  Capsules. 

Their  size  is  remarkable;  the  older  the  subject  the  smaller 
they  are. 

Their  color  is  peculiar,  yellow  brown. 

Also  their  shape  :  a  liberty  cap. 

Also  their  situation :  over  the  kidney,  with   which  they 
have  no  connection,  neither  anatomical  nor  physiological. 

Their  structure  is  peculiar   in<  containing   some  special 
stellate  bodies. 

It  has  a  cavity  in  its   centre ;  the  only  lymphoid  gland 
having  it,  except  the  pituitary  body. 

The  arteries  are  numerous,  specially  compared  with  the 
size  of  the  organ. 
Peculiarities  of  the  Kidneys. 

Their  color  is  peculiar  (like  the  liver)- 

They  are  situated  at  the  deepest  part  of  the  abdominal 
cavity: 

The  right  is  lower  than  the  left. 

Their  shape  is  unique  :  that  of  a  bean. 

The  hilum  is  one  of  the  most  distinct  (like  the  liver)- 

The  upper  extremity  is  the  largest  (like  the  spleen). 

The  posterior  surface  is  free  from  peritoneum  and  can  lie 
entered  from  behind  without  injuring  the  peritoneum. 

It  possesses  a  cellulo-adipose  capsule  (a  unique  instance). 

Its  proper  tissue  is  characteristic. 

The  cortical  is  unique. 

The  pyramids  are  unique. 

The  harder  of  the  two  substances  is  in  the  centre. 

The  dichotomous  division  of  the  canalicules  is  unique. 

It  is  the  only  tubular  gland  that  is  Lobulated   (pyramids 
of  Ferrein)  with  the  testicles. 


40  PROSTATE. 

The  Malpighian  Corpuscle  is  unique  (it  is  very  different 
from  the  splenic  corpuscle). 

The  Glomerule  is  unique. 

The  Capillary  Arterial  Portal  System  is  unique. 

The  Arteries  are  very  large  in  proportion  to  the  organ. 

The  smaller  branches  run  between  the  pyramids  of  Fer- 
rein  in  a  peculiar  way. 

The  Veins  are  peculiarly  larger  than  the  arteries ;  they 
carry  red  Wood. 

They  originate  not  from  the  glomerule,  but  from  the  cap- 
illary plexus,  etc. 

The  superficial  Venous  Capillaries  originate  on  the  sur- 
face of  the  kidney  in  a  star-like  arrangement  called  the 
Stars  of  Verheyn. 

The  left  is  lower  than  the  right. 

They  carry  purer  blood  than  the  arteries. 

The  vessels  are  in  front  of  the  pelvis  and  are  away  from 
the  knife  in  operations  on  the  kidney  and  pelvis. 

108  Peculiarities  of  the  Excretory  Apparatus  of  the  Kidneys. 

Is  very  peculiar. 

The  real  beginning  of  the  apparatus  is  the  canicules  from 
the  corpuscles  to  the  calices. 

The  balance  is  represented  by  the  calices,  the  pelvis,  the 
ureter,  the  bladder,  the  urethra. 
Peculiarities  of  the  Calices. 

Are  unique  :  no  similar  arrangement  exists  anywhere  else. 
Peculiarities  of  the  Pelvis. 

Is  also  unique :  nothing  similar  is  found  anywhere  else. 

109  Peculiarities  of  the  Ureters. 

Are  peculiar  on  account  of  their  length  and  size. 

Also  on  account  of  their  mode  of  termination  into  the 
bladder. 
Peculiarities  of  the  Bladder. 

Is  the  largest  receptacle  found  on  the  course  of  any  ex- 
cretory apparatus. 

Its  shape  is  unique,  having  two  apices,  the  neck  and  the 
urachus. 

The  anterior  surface  is  deprived  of  peritoneum. 

The  urachus  is  unique. 

The  Base  is  also  deprived  of  peritoneum. 

The  Neck  with  a  sphincter  is  unique,  in  an  excretory  ap- 
paratus. 

It  has  three  sets  of  fibres  (like  the  stomach). 

The  Mucous  Coat  is  reticulated  (like  the  gall  bladder). 

Its  bas-fond  is  unique. 

The  trigone  is  unique. 

The  Arteries  are  numerous,  three  on  each  side. 

The  Veins  form  a  plexus  around  the  neck. 

The  nerves  of  the  neck  come  from  the  hypogastric 
plexus. — The  nerves  of  the  base  come  from  the  sacral 
plexus. 


.MALE   ORGANS   OK   GENERATION — SCROTUM — TESTICLE.  41 

Peculiarities  of  the  Prostate. 

Is  unique. 

Its  size  increasing  with  age  is  unique. 

Its  color  is  fleshy  (like  the  thyroid  body  and  thymus). 

Its  shape  is  unique. 

Its  urethral  crest  and  utricle  are  unique. 

Its  being-  traversed  by  the  urethra  and  ejaculatory  duds 
is  unique. 

Its  stroma  of  smooth  muscular  fibres  is  unique. 

Its  excretory  ducts  are  numerous  (like  the  sublingual). 

It  is  the  analogue  of  the  female  uterus,  but  the  uterine 
glands  are  tubular. 

The  Veins  surrounding  it  are  numerous. 

MALE  ORGANS  OF  GENERATION. 

110  Enumeration.  The  male  organs  of  generation  consist  of 
the  Scrotum,  the  Testicle,  the  Epididymis,  the  Spermatic 
Duct,  the  Seminal  Vesicles,  the  Ejaculatory  Ducts,  the  Penis, 
and  the  Urethra. 

SCROTUM. 

111  Structure.     The  scrotum  is  composed  : 

1st,  of  the  Skin  or  Scrotum  Proper-. 

2d,  of  the  Dartos  and  Dartoic  Tunic,  composed  of  elastic 
and  smooth  muscular  fibres. 

3d,  of  the  Erythroid  Tunic,  formed  by  the  Cremaster  mus- 
cle. 

4th,  of  the  Fibrous  Tunic,  corresponding  to  the  Fascia 
Tran  sversalis. 

5th,  of  the  Vaginal  Tunic,  which  is  a  serous  membrane 
lining  the  inner  surface  of  the  fibrous  tunic  and  the  outer 
surface  of  the  testicle  and  epididymis. 

TESTICLE. 

112  Shape.  The  testicle  resembles  a  pigeon's  egg,  slightly  flat- 
tened transversely. 

The  External  Surface,  the  Internal  Surface  and  the  Ante- 
rior Border  are  convex  and  smooth. 

The  Posterior  or  Upper  Border  adheres  to  the  epididymis 
except  in  the  middle. 

The  Anterior  or  Upper  Extremity  and  the  Posterior  or 
Lower  Extremity  are  convex  and  smooth. 
Structure.  The  testicle  is  composed: — 1st,  of  a  Serous 
Layer  formed  by  the  vaginal  tunic: — 2d,  of  the  Albugineous 
or  Fibrous  Goat,  very  strong  and  unyielding — thickened  at 
the  back  part  of  the  testicle  to  form  the  mediastinum; — it 
contains  the  longitudinal   mediastinal  ducts  which  open  into 


42  EPIDIDYMIS — SPERMATIC   DUCT. 

the  vascular  cones  of  the  epididymis; — 3d,  of  Alveoles  con- 
taining the  Seminiferous  Canalicules  which  open  into  the 
mediastinal  ducts  and  which  are  lined  by  the  special  Sperm 
Cells. 

EPIDIDYMIS. 

113  Shape.  The  Epididymis  is  elongated  and  narrow,  and  re- 
sembles a  leech. 

The  Upper  Surface  is  partly  free  and  partly  adherent  to 
the  fibrous  portion  of  the  vaginal  tunic. 
The  Under  Surface  is  adherent  to  the  testicle  in  front  and 
behind, — but  is  free  in  the  middle. 

The  Anterior  Extremity  or  Head  is  firmly  attached  to  the 
testicle. 

The  Posterior  Extremity  or  Tail  is  also  adherent  to  the 
testicle. 

Structure.  The  epididymis  is  composed: — 1st,  of  a  Serous 
Coat  from  the  vaginal  tunic; — 2d,  of  a  Fibrous  or  Albugine- 
ous  Coat  similar  to  that  of  the  testicle ; — 3d,  the  Head  is 
composed  of  a  dozen  convoluted  tubes  called  the  Spermatic 
Cones  which  originate  from  the  mediastinal  ducts  and  ter- 
minate in  a  single  coarse  convoluted  tube, — the  Canal  of  the 
Epididymis  forming  the  body  and  tail  of  the  organ ;  it  is 
continuous  with  the  spermatic  duct. 

SPERMATIC  DUCT  (VAS  DEFERENS). 

114  Direction  and  Course.  The  spermatic  duct  ascends  with 
the  spermatic  vessels  in  the  scrotum; — it  traverses  the  in- 
guinal canal, — then  curves  into  the  pelvic  cavity  to  reach 
the  side  of  the  bladder  and  the  fundus,  where  it  joins  the 
excretory  duct  of  the  seminal  vesicle. 

Shape.  It  is  a  long,  small,  hard  duct. 
The  Surfaces  are  in  relation: — In  the  Scrotum,  with  the  ves- 
sels behind  which  it  is  situated ; — in  the  Inguinal  canal  the 
duct  rests  on  the  floor; — at  the  Internal  Inguinal  Orifice  it 
becomes  separated  from  the  vessels  ; — in  the  Pelvis  it  rests  on 
the  sides  of  the  bladder,  crossing  the  ureter ; —  beneath  the 
fundus  it  lies  to  the  inner  side  of  the  seminal  vesicles. 
The  Outer  Extremity  is  continuous  with  the  canal  of  the 
epididymis. 

The  Inner  Extremity  is  continuous  with  the  duct  of 
the  seminal  vesicle  —  and  forms  with  it  the  ejaculatory 
duct. 

Structure.  The  spermatic  duct  is  very  thick,  with  a  small 
capillary  channel.  It  is  composed: — 1st,  of  a  Fibrous  Coat 
and — 2d,  of  a  Mucous  Coat  lined  by  a  stratified  columnar 
epithelium. 


SPERMATIC   CORD — E.TACULATORY    DUCTS — PENIS.  4-'> 


SPERMATIC  CORD. 

115  Structure.  The  spermatic  cord  is  composed  of  the  8pt r- 
matic  duct,  the  spermatic  artery,  the  spermatic  veins,  lym- 
phatic vessels,  sympathetic  nervous  filaments;  of  areolar  tissue 
and  of  a  portion  of  the  fibrous  layer  of  the  scrotum  and  cre- 
master  muscle. 

SEMINAL  VESICLES. 

116  Shape.     The  seminal  vesicles  are  flattened  oval  bodies. 
The  Under  Surface  is  convoluted  —  it  is  in  relation  with 
the  rectum. 

The  External  Border  is  convex  and  sacculated. 
The  Internal  Border  is  in  relation  with  the  spermatic  duet. 
The  Posterior  Extremity  is  rounded  and  free. 
The  Anterior  Extremity  gives  rise  to  the  ejaculatory  duct ; 
—  it  is  in  relation  with  the  base  of  the  prostate. 
The   Upper  Surface  is  in  relation  with  the  base  of   the 
bladder. 

Structure.  The  seminal  vesicles  are  composed  : — 1st,  of  an 
External  Fibrous  Coat; — 2d,  of  a  Coarse  Tube  closed  at  its 
posterior  extremity,  convoluted  into  a  mass  presenting  di- 
verticles  ; — the  walls  of  this  tube  are  formed  of  a  flbro-mus- 
cular  coat  lined  by  a  reticulated  mucous  layer  with  cylin- 
drical epithelium. 

EJACULATORY  DUCTS. 

117  Shape.     The  ejaculatory  ducts  are  conical  tubes. 

The  Surfaces  and  Borders  are  intimately  adherent  to  the 
prostatic  tissue. 

The  Posterior  Extremity  communicates  with  the  seminal 
vesicle  and  ejaculatory  duet. 

The  Anterior  Extremity  opens  into  the  urethra  by  a  slit- 
like orifice  on  the  side  of  the  utricle. 

Structure.  The  Ejaculatory  ducts  are  composed  of  a  Fibro- 
Muscular  layer  lined  by  Mucous  Membrane. 

PENIS. 

118  Structure.  The  penis  is  composed,  from  the  surface  to  tin- 
deep  parts : —  1st,  of  the  Skin ; — 2d,  of  a  Dartoic  Layi  >•; — 3d. 
of  a  Fibro-elastic  Sheath  binding  together  the  three  bodies 
forming  the  bulk  of  the  penis  ; — 4th.  of  the  Two  Cavi  rnous 
Bodies  composed  of  an  external  albugineous  fibrous  layer  and 
of  alveoles  into  which  the  capillary  arteries  open  by  a 
free  extremity  and  from  which  the  venous  radicles  origi- 


44  MALE   URETHRA — COWPER'S   GLANDS. 

nate  by  a  dilated  extremity; — 5th,  of  the  Spongy 
Body,  which  is  traversed  by  the  urethra ; —  it  pre- 
sents in  front  an  expansion  called  the  Glans  Penis 
and  one  behind  called  the  Bulb  of  the  nrethra; — 
it  has  the  same  structure  as  the  cavernous  bodies,  only 
the  fibrous  layer  is  thinner  and  the  alveoles  smaller. 

MALE  URETHRA. 

119  Dimensions.    The  male  urethra    measures  from  eight  to 
ten  inches  ; —  the  prostatic  measures  one  inch  and  a  quar- 
"  ter, —  the  membranous  three-quarters  of  an  inch  —  and  the 
spongy  about  six  inches. 

Diameters.  The  meatus  is  the  narrowest  part; — then  it 
expands  to  form  the  Navicular  Fossa  —  and  contracts  again 
along  the  spongy  body ; —  the  membranous  portion  is  nar- 
rower than  the  spongy  but  is  dilatable; — the  prostatic  por- 
tion is  the  widest  and  is  the  most  dilatable. 
Direction.  In  the  flaccid  state  it  presents  two  curves  and  re- 
sembles an  italic  #; — in  the  straightened  or  erect  state  there 
is  but  one  curve,  the  permanent  curve,  with  the  concavity  di- 
rected upwards  ; —  it  extends  from  the  bulb  to  the  bladder, 
passing  through  the  middle  perineal  fascia ; — it  has  its  cen- 
tre a  little  behind  the  pubis. 

Shape.     The  urethra  is  cylindrical,  in  a  general  way. 
The  External   Surface  adheres  closely  to   the    structures 
which  it  traverses. 

The  Internal  Surface  presents  in  the  spongy  portion  and 
on  the  upper  wall  principally  blind  pouches. —  In  the  bulbous 
portion,  on  the  floor,  it  presents  the  orifices  of  Couper's 
glands. —  In  the  prostatic  portion  it  presents  on  the  floor 
also  the  urethral  crest,  the  utricle,  the   opening  of  the  ejacu- 

latory  ducts  and  of  the  prostatic  ducts.  

Structure.  The  urethra  is  composed  : — 1st,  Of  a  Mucous 
Membrane  with  a  columnar  epithelium  and  simple  racemose 
glands; — 2d,  Of  a  Fibro-elastic  and  Muscular  Submucous 
Layer; —  3d,  In  its  course  from  the  bladder  to  the  meatus, 
the  canal  thus  constituted  is  reinforced  by  the  organs  which 
it  traverses ;  i.e.,.  the  prostate,  membranous  urethra  and 
spongy  body,  which  form  additional  coverings  or  walls. 

COWPER'S  GLANDS. 

120  Dimensions.     Cowper's  glands  are  about  the  size  of  a  cow- 
pea. 

Situation.  They  are  situated  in  the  folds  of  the  middle 
perineal  fascia. 

Structure.  They  are  racemose  glands; — the  ducts  open 
on  the  floor  of  the  bulbous  urethra. 


PECULIARITIES   OF   THE    .MALE   ORGANS   OP   GENERATION.        4.") 

PECULIARITIES    OF   THE    MALE    ORGANS 
OF   GENERATION. 

Peculiarities  of  the  Scrotum. 

The  thinness  of  the  Skin  is  noticeable  when  not  corru- 
gated (like  the  penis  and  lids). 

The  Hair  follicles  are  particularly  large. 

The  Dartoic  Tunic  corresponds  to  the  subcutaneous  areo- 
lar tissue  in  other  situations. 

It  is  very  abundant. 

It  is  mixed  with  smooth  muscular  fibres. 

Fat  never  accumulates  in  it  (like  the  lids  and  penis). 

The  Erythroid  Tunic  and  Cremaster  Muscle  are  unique. 

The  Fibrous  Tunic  corresponds  to  the  pericardium  and  to 
the  dura  mater. 

The  Vaginal  Tunic  is  peculiar  in  having  been  formed  by 
the  peritoneum. 
Peculiarities  of  the  Testicles. 

Are  unique. 

That  one  is  larger  and  hangs  lower  than  the  other  is 
peculiar. 

Their  shape  is  unique. 

The  thickness  of  the  fibrous  coat  is  peculiar. 

The  presence  of  the  Mediastinum  is  peculiar. 

The  Mediastinal  Ducts  are  unique. 

The  division  of  the  interior  into  alveoles  is  more  marked 
here  than  anywhere  else. 

The  lobulated  condition  is  shared  by  the  kidneys. 

The  diverticles  on  the  seminiferous  canalicules  are 
unique. 

The  sperm  cells  lining  the  canalicules  are  unique  (the 
peptic  glands  recall  this,  i.  e.,  the  presence  of  peculiar  cells 
lining  some  tubular  glands). 

The  Artery  is  peculiar  for  its  origin  so  far  away  from  the 
organ. —  Also  for  its  slender  size. —  Also  for  its  close  at- 
tachment to  the  spermatic  duct. 

The  Capillaries  form  a  peculiar  layer  on  the  walls  of  the 
alveoles. 

The  Lymphatics  discharge  in  the  pelvis  glands. 

The  Nerves  are  peculiar,  and  pressure  on  the  organs  pro- 
duces a  characteristic  sickening  feeling. 
Peculiarities  of  the  Epididymis. 

It  is  unique. 

It  is  the  beginning  of  the  excretory  apparatus  of  lie- 
testicle,  which  comprises  the  mediastinal  duct,  the  cones  and 
canal  of  the  epididymis, — the  spermatic  duct,  the  seminal 
vesicles,  the  urethra. 

Its  shape  is  unique. 

Its  fibrous  coat  is  thick  and  unyielding  (like  the  testicle 
and  the  sclerotic). 


46        PECULIARITIES   OF  THE   MALE   ORGANS   OF   GENERATION. 

The  spermatic  cones  are  unique. 
The  Canal  of  the  Epididymis  is  unique. 
"•23  Peculiarities  of  the  Spermatic  Duct. 

It  is  remarkable  for  its  length ;  it  is  the  longest  of  all  ex- 
cretory ducts. 

Its  independence  from  the  veins  and  other  parts  of  the 
spermatic  cord  is  peculiar. 

It  joins  another  duct  (like  the  common  bile  duct). 

Its  small  size  is  peculiar. 

Also  the  thickness  of  its  walls  and  its  small  calibre  (like 
the  parotid). 

The  Spermatic  Artery  is  closely  attached  to  it. 

Its  veins  are  loose  and  away  from  it. 
Peculiarities  of  the  Spermatic  Cord. 

It  recalls  the  umbilical  cord. 

Only,  it  has  but  one  artery  and  several  veins,  whereas  the 
umbilical  cord  has  one  single  vein  and  several,  i.  e.,  two 
arteries. 

The  Veins  are  loose  and  away  from  the  spermatic  duct. — 
They  terminate  on  the  right  in  the  Inferior  Cava  and  on  the 
left  into  the  Renal  Vein. 
Peculiarities  of  the  Seminal  Vesicles. 

Are  the  analogues  of  the  gall  bladder  and  the  urinary 
bladder. 

Their  shape  is  peculiar. 

The  sacculated  or  grooved  appearance  of  their  surface  is 
peculiar. 

The  partitioned  appearance  of  the  interior  is  unique. 

They  possess  smooth  muscular  fibres  in  their  walls  (like 
the  gall  bladder). 
Peculiarities  of  the  Ejaculatory  Ducts. 

They  resemble  the  Common  Bile  Duct. 

They  are  peculiar  in  traversing  the  prostate  gland  itself. 
124  Peculiarities  of  the  Penis. 

It  is  unique  in  all  respects. 

It  corresponds  to  the  female  clitoris. 

The  skin  is  thin  (like  the  lids  and  scrotum). 

The  Dartoic  layer  has  not  so  many  muscular  fibres  as  the 
scrotum. 

The  Two  Cavernous  Bodies  are  unique. —  The  Two  Roots 
are  peculiar. —  Their  Anterior  Blunt  Extremity  is  peculiar. 
— The  absence  of  communication  with  the  spongy  body  is 
peculiar. —  Their  Fibrous  Coat  is  peculiarly  thick  and  un- 
yielding (like  testicle,  epididymis,  sclerotic). 

The  Spongy  Body  is  peculiar. —  Its  expansion  anteriorly 
to  form  the  glans  and  posteriorly  to  form  the  bulb  is 
peculiar. 

The  Structure  of  these  three  bodies  is  peculiar ;  that  of 
all  erectile  tissue  (like  the  spleen). 

The  Penis  has  two  arteries  to  one  vein. 


PERICARDIUM — HEART.  47 

The  Capillaries  have  ;i   corkscrew  course  and  terminate 

by  opened  extremities. 

The  Capillaries  Proper  are  replaced  by  the  cavities  of  tie- 
erectile  tissue. 

The  Venous  Capillaries  begin  by  an  open  dilated  ex- 
tremity. 

The  Vein  is  unique. — It  has  no  valves. 

The  Lymphatics  from  the  skin  empty  into  the  inguinal 
glands,  while  those  of  the  deeper  structures  empty  in  the 
pelvic  gland. 

The  Nerves  terminate  in  the  glans  in  peculiar  corpuscles. 
Peculiarities  of  the  Hale  Urethra. 

It  is  peculiar  in  its  length. 

In  its  varying  diameters  (like  the  oesophagus). 

In  its  direction,  presenting  a  changeable  and  a  permanent 
curve. 

It  is  remarkable  because  it  traverses  three  different  struct- 
ures or  regions. 

Its  internal  surface  presents  the  blind  pouches,  also  the 
urethral  crest,  the  utricle,    the    slit-like  openings  of  the 
ejaculatory  ducts,  the  many  openings  of  the  prostate  glands 
and  openings  of  Cowper's  glands. 
Peculiarities  of  Cowper's  Glands. 

Are  peculiar  in  their  situation. 

Also  because  they  correspond  to  the  glands  of  Bartholin 
in  the  female. 

PERICARDIUM. 

125  1st,  The  Fibrous  Pericardium. 

Shape.     The  fibrous  pericardium  is  conical. 

The  Anterior  Surface  is  in  relation  with  the  sternum. 

The  Lateral    Surfaces  are  in   relation   with   the   phrenic 

nerves,  the  pleura  and  lungs. 

The  Base  is  closely  attached  to  the  aponeurotic  diaphragm. 

The  Apex  surrounds  the  large  vessels  at  the  base  of  the 

heart. 

The   Posterior  Surface    is    in    relation   with    the    trachea. 

bronchi,  oesophagus,  aorta. 

126  2d,  The  Serous  Pericardium. 

Course.  The  serous  pericardium  invests  the  interior  of  the 
fibrous  pericardium  —  it  is  then  reflected  upon  the  surface  of 
the  heart. 

HEART. 

127  Shape.     The  heart  is  conical,  a  little  flattened  from  before 
backwards. 

The  Anterior  Surface  presents  the  anterior  interventricu- 
lar and  auriculo-ventricular  grooves  — the  initial  portions 

of  the  aorta  and  pulmonary  artery.— the  lefl  and  right 
auricular  appendages. 


48  PECULIARITIES   OF  THE   ORGANS   OP   CIRCULATION. 

The  Upper  or  Left  Border  is  the  sharpest. 
The  Lower  or  Right  Border  is  the  broadest  and  is  almost 
straight; — it  rests  upon  the  aponeurotic  diaphragm. 
The  Base  is  turned  upwards  and  to  the  right ;    it  presents 
the  pulmonary  artery,  the  aorta,  the  descending  cava,  the 
upper  or  left  pulmonary  veins. 

The  Apex  or  Point  corresponds  to  the  fifth  intercostal 
space,  a  little  below  and  to  the  right  of  the  left  nipple. 
The  Posterior  Surface  presents  the  posterior  interventric- 
ular and  auriculo -ventricular  grooves,  the  ascending  cava, 
the  great  coronary  vein  and  the  two  lower  or  right  pulmo- 
nary veins. 

STRUCTURE  OF  THE  HEART. 

128  The  heart  is  composed  : 

1st,  of  the  Visceral  Layer  of  the  serous  pericardium. 
2d,  of  a  Muscular  Layer. —  In  the  Auricles  there  is  a  su- 
perficial common  circular  layer  and  a  separate  loop-like  set 
of  fibres  for  each  auricle,  attached  to  the  fibrous  rings  of 
the  orifices; — there  is  a  set  of  circular  fibres  around  the 
orifices  of  the  large  veins.  In  the  Ventricles  there  is  the 
same  arrangement,  but  at  the  apex  the  fibres  penetrate  into 
the  ventricles  and  form  the  Fleshy  Columns  or  Muscles. — 
The  fibres  are  striated,  are  narrow  and  anastomose. 

3d,  of  an  Internal  Serous  Layer  called  the  Endocardium, 
lining  the  interior  of  the  cavities  of  the  heart. 
In  the  Auricles,  the  Inner  Wall  presents  the  inter-auricular 
septum  or  oval  fossa ; — the  Outer  Wall  presents  the  orifice 
of  the  auricular  appendage ; — the  Anterior  Wall  presents 
nothing  special ; —  the  Posterior  Wall  presents  on  the  right 
side  the  orifice  of  the  ascending  and  descending  cava  and 
on  the  left  side  the  orifices  of  the  pulmonary  veins ; — 
the  Lower  Wall  presents  the  auriculo -ventricular  orifice  and 
valve. 

In  the  Ventricles  we  find  the  Fleshy  Columns  or  Muscles 
and  Tendinous  Cords ; —  the  Inner  Wall  forms  the  interven- 
tricular septum, —  the  Anterior  and  Posterior  Walls  and  the 
Apex  are  covered  with  fleshy  columns ; —  the  Base  presents 
the  auriculo-ventricular  orifices  and  valves,  the  tricuspid  on 
the  right  and  the  mitral  on  the  left; — it  presents  also  the 
Pulmonary  and  Aortic  Orifices  guarded  each  by  a  set  of 
semi-lunar  valves. 

PECULIARITIES  OF  THE  CENTRAL  ORGANS  OF 
CIRCULATION. 

129  Peculiarities  of  the  Fibrous  Pericardium. 

It  is  most  peculiar  and  almost  unique. 

Its  walls  resemble  the  fibrous  tunic  of  the  scrotum. 


RESPIRATORY  ORGANS — LARYNX.  4!l 

It  was  rendered  necessary  here  from  the  lack  of  any  other 
support  for  the  serous  pericardium. 

Its  base  corresponds  to  the  point  of  the  heart. 

This  base  is  attached  to  the  aponeurotic  diaphragm. 

The  lateral  surfaces  are  lined  by  a  serous  membrane,  the 
pleura;  it  is  therefore  placed  between  two  serous  mem- 
branes. 

The  phrenic  nerves  take  support  on  the  lateral  surfaces. 
Peculiarities  of  the  Heart. 

Is  a  unicpie  organ  in  the  body. 

The  whole  of  it  is  peculiar  and  must  be  studied  as  such. 

A  most  peculiar  feature  is  that  although  it  is  an  organ 
which  is  not  under  the  influence  of  our  will,  yet  its  fibres 
are  striped  fibres. 

Besides,  those  fibres  are  narrower  than  anywhere  else. 

Also  they  anastomose,  which  is  a  unique  instance. 

The  arteries  are  numerous. 

They  originate  below  the  edge  of  the  semilunar  valves. 

They  fill  during  ventricular  diastole  and  by  arterial  sys- 
tole. 

They  form  two  circles,  one  in  the  interventricular  groove 
and  the  other  around  the  base  in  the  auriculo-ventricular 
groove. 

The  veins  form  two  groups. 

Those  of  the  left  heart  centre  into  the  Great  Cardiac  Vein, 
which  presents  an  effective  valve. 

It  is  the  only  vein  of  the  heart  having  an  effective  valve. 

The  right  heart  is  drained  by  the  peculiar  veins  of  Thebe- 
sius. 

The  Nerves  come  from  the  peculiar  cardiac  plexus. 

Three  from  the  sympathetic  and  three  from  the  cervical 
plexus. 

They  present  the  Ganglion  of  Remak  at  the  base  of  tin- 
heart. 

The  inhibitory  or  moderating  nerve  is  the  sympathetic. 

RESPIRATORY   ORGANS. 

130  Enumeration.  The  organs  of  respiration  are:  the  Larynx. 
Trachea,  Bronchi,  Lungs,  Pleura,  Thyroid  Body  and  Thy- 
mus Gland. 

LARYNX. 

131  Shape.     The  larynx  is  triangular  and  prismatic. 

The  Base  is  turned  upwards  and  corresponds  t<»  the  hyoid 

bone. 

The  Apex  is  turned  downwards  and  is  continuous  with  the 

trachea. 

The  Anterior  Border  presents  a  projection  called   Adams 

Apple;  it  is  subcutaneous. 

4 


50  STRUCTURE  OF  THE  LARYNX. 

The  Lateral  Surfaces  are  in  relation  with  the  sterno-hyoidy 
omohyoid,  thyro-hyoid  and  sterno-thyroid  and  the  skin. 
The  Lateral  Borders  give  attachment  to  the  pharynx. 

The  Posterior  Surface  is  situated  in  the  lower  portion  of 
the  pharynx. —  It  presents  from  above  downward  the  Epi- 
glottis and  its  Folds  (the  middle  and  lateral  glosso-epiglottic 
and  the  aryteno-epiglottic) — the  orifice  of  the  larynx, —  a 
square  surface,  corresponding  to  the  cricoid  cartilage. 

The  Interior  of  the  Larynx  presents  the  upper  glottic  space  ; 
—  the  upper  or  false  vocal  cords, —  the  ventricle, —  the  lower 
or  true  vocal  cords  limiting  the  glottis  or  rima, —  the  inter- 
arytenoid  space, —  the  inferior  or  lower  glottic  space. 

STRUCTURE  OF  THE  LARYNX. 

132  The  larynx  is  composed:  of  bone,  cartilages,  fibro -cartilage, 
articulations,  muscles,  mucous  membrane,  vessels  and 
nerves. 

1st.  The  Bone  is  the  hyoid. 

2d.  The  Cartilages  are  the  thyroid,  cricoid,  arytenoid, 
cuneiform  and  corniculate. 

3d.  The  Fibro=Cartilage  is  the  epiglottis. 

4th.  The  Articulations  of  the  larynx  are  the  crico-thy- 
roid  (median  or  anterior  and  lateral  or  posterior); — the 
crico-arytenoid, —  the  aryteno-thyroid  (or  ligaments  of  the 
true  and  the  false  vocal  cords)  ; —  the  ligaments  of  the  epi- 
glottis, which  are  the  hyo-epiglottic,  the  thyro-epiglottic, 
the  aryteno-epiglottic,  and  the  glosso-epiglottic. 

5th.  The  Muscles  are  the  crico-thyroid, —  the  thyro-epi- 
glottic,— the  aryteno-epiglottic  superior, —  the  aryteno-epi- 
glottic inferior, — the  crico-arytenoid  lateral, — the  crico-aryt- 
enoid posterior, —  the  arytenoid. 

The  muscle  which  opens  the  glottis  is  the  crico-arytenoid 
posterior. 

The  muscles  which  close  the  glottis  are  the  arytenoid  and  the 
crico-arytenoid  lateral. 

The  muscle  which  tenses  and  elongates  the  vocal  cords  is  the 
crico-thyroid. 

The  muscle  which  relaxes  and  shortens  the  vocal  cords  is  the 
thyro-arytenoid. 

6th.  The  Mucous  Membrane  is  lined  by  a  ciliated  epithe- 
lium—  it  has  numerous  simple  racemose  glands. 

7.  The  Nerves  of  the  Larynx  are :  1st,  the  Superior 
Laryngeal,  distributed  to  the  crico-thyroid  and  to  the  mucous 
membrane  ; —  2d,  the  Inferior  or  Recurrent  Laryngeal,  distrib- 
uted to  all  the  other  muscles  and  also  to  the  mucous  mem- 
brane. 


TRACHEA — BRONCHI.  •">! 


TRACHEA. 


133  Shape.  The  trachea  is  cylindrical,  but  flattened  behind. 
The  Anterior  Surface  presents  ridges  and  grooves  corre- 
spondingto  the  cartilages  and  their  spaces. — It  is  in  relation 
in  the  neck  with  the  isthmus  of  the  thyroid  body,  the  middle 
thyroid  artery  aud  vein,  the  fascia  and  skin  ; —  in  tin  chest, 
with  the  left  innominate  vein,  the  arch  of  the  aorta  and  the 
pericardium. 

The  Lateral  Surfaces  present  also  ridges  and  grooves. 
They  are  in  relation — in  the  neck  with  the  lobes  of  tin-  thy- 
roid body,  the  sterno-thyroid,  the  sterno-hyoid,  the  carotid 
and  the  recurrent  laryngeal; —  in  the  chest  on  the  right  with 
the  innominate  artery,  the  right  carotid,  and  on  the  left 
with  the  left  carotid  and  the  arch. 
The  Upper  Extremity  is  continuous  with  the  trachea. 
The  Lower  Extremity  divides  into  the  right  and  left 
bronchi. 

The  Posterior  Surface  is  flattened; — it  has  no  rings  and 
is  membranous. — It  is  in  relation  all  along  with  the  oesoph- 
agus and  pneumo-gastric  nerves. 

134  Structure.     The  trachea  is  composed :  1st,  of  Cartilaginous 

Segments  connected  by  Fibrous  Tissue; — 2d,  the  Posterior 
Wall  is  altogether  membranous; — 3d,  of  a  layer  of  Trans- 
verse, smooth  muscular  fibres; — 4th,  of  a  layer  of  Longitudi- 
nal elastic  fibres; — 5th,  of  a  Mucous  layer  with  a  ciliated 
epithelium  —  and  provided  with  simple  racemose  glands. 

BRONCHI. 

135  Shape.  The  Bronchi  are  cylindrical,  but  flattened  behind. 
The  Anterior  Surface  presents  cartilaginous  ridges  and 
fibrous  interstices. — It  is  in  relation  with  the  pericardium, 
pulmonary  artery  aud  veins,  and  bronchial  artery  and  veins  ; 
— the  right  is  in  relation  with  the  descending  cava. 

The  Upper    Surface   on  the  right  is  arched  over   by   the 

great  azygos  vein, —  and  on  the  left  by  the  arch  of  the  aorta. 

The  Under  Surface  gives  attachment  to  the  ligamenl  of  the 

bronchi  and  to  the  broncho-phrenic  ligament. 

The  Posterior  Surface  is  flat  and  membranous. — It  is   in 

relation  on  the  right  with  the  azygos    vein  and  on  the  left 

with  the  aorta. 

The  Internal  Extremity    is  continuous  with  the  trachea. 

The  External  Extremity  penetrates  into  the  lung.  —  where 

it  divides  diehotomouslv.  each  division   ending  in  a  dilated 

extremity  which  forms  the  pulmonary  lobule. 

136  Structure.  The  Large  or  Extra-Pulmonary  Bronchi  have 
the  same  structure  as  the  trachea. — The  Medium-sized  Bron- 
chi have  also  the  same  structure,  hut  the  cartilage  segments 
form  complete  rings. —  In  the  Smaller  Bronchiihe  cartilages 


52  LUNGS — PLEURA. 

gradually  disappear. — In  the  Terminal  &nd.mCapillary  Bronchi, 
there  exists  only  a  fibro-elastic  layer  with  circular  smooth 
fibres  and  a  lining  mucous  membrane. 

LUNGS. 

137  Shape.     The  lungs  are  conical. 

The  External  Surface  is  convex; — it  presents  the  interlo- 
bar fissures  dividing  the  right  lung  into  three  lobes  and  the 
left  into  two  lobes. 

The  Internal  Surface  is  concave; — it  presents  near  the 
middle  a  deep  groove,  the  Mlum  through  which  the  bronchi, 
the  veins  and  the  pulmonary  artery,  the  bronchial  artery 
and  the  nerves  penetrate  into  the  lung  and  the  correspond- 
ing veins  and  the  lymphatics  come  out ;  —  all  those  elements 
are  surrounded  by  the  pleura  and  form  the  root  or  pedicle 
of  the  lung. 

The  surface  behind  the  hilum  corresponds  to  the  posterior 
mediastinum. 

The  surface  in  front  corresponds  to  the  pericardium  and 
heart. 

The  surface  above  to  the  superior  mediastinum. 
The  Anterior  Border  is  thin  and  rests  on  the  pericardium. 
The    Base   .or    Under    Surface   corresponds   to   the   dia- 
phragm. 

Th,e  Apex  extends  above  the  level  of  the  first  rib  into  the 
supra-clavicular  region, — where  it  is  in  relation  with  the 
large  vessels  and  nerves  of  that  region. 

The  Posterior  Border  is  thick  —  it  lies  on  the  side  of  the 
vertebral  column. 

138  Structure.  The  lungs  are  composed: — 1st,  of  a  Serous  or 
Pleural  Coat ; —  2d,  of  a  Fibro-elastic  Coat  situated  under- 
neath it; — 3d,  the  Proper  Tissue  is  composed  of  alveoles 
called  lobules,  which  may  be  considered  as  the  dilated  ter- 
mination of  the  capillary  bronchi; — the  interior  of  the  lob- 
ules present  innumerable  small  depressions  or  pouches, 
which  are  the  air  vesicles. — The  walls  of  the  lobules  and  air 
vesicles  are  formed  of  delicate  connective  and  elastic  tis- 
sue;—  they  are  lined  by  delicate  epithelial  plates; — 4th, 
the  Arteries  are  the  pulmonary  and  the  bronchial  or  nu- 
trient ; — 5th,  the  Veins  are  the  bronchial  and  the  pulmo- 
nary. 

PLEURA. 

139  Shape.     The  pleura  has  the  shape  of  a  conical  bag. 

The  External  Surface  lines  the  walls  of  the  chest  and  is 

then  reflected  on  the  lungs. 

The  Internal  Surface  is  reflected  upon  itself. 


PECULIARITIES  OF  THE  ORGANS  OF  RESPIRATION.  53 


PECULIARITIES    OF    THE    ORGANS    OF    RESPIRATION. 

140  Peculiarities  of  the  Larynx. 

It  is  a  unique  organ  in  the  body. 

The  whole  of  it  is  peculiar  and  must  be  studied  as  such. 

The  True  Vocal  Cords  are  its  most  peculiar  poiuts. 

The  Ventricle  of  the  larynx  is  also  remarkable. 

The  Connective  Tissue  of  the  epiglottic  fibres  must  be 
noticed. 

The  Arytenoid  Cartilages  are  the  centre  or  pivol  of  the 
whole  larynx,  because  the  vocal  cords  are  attached  to  them 
behind,  and  because  of  this,  almost  all  the  importanl  mus- 
cles of  the  larynx  are  attached  to  them. 

The  Cricoid  is  the  first  ring  of  the  trachea. 

The  Nerves  are  peculiar. — The  Inferior  Recurrent  Laryn- 
geal nerve  specially  by  its  origin,  its  course,  its  termina- 
tion. 

141  Peculiarities  of  the  Trachea. 

Is  a  unique  organ. 

Its  elasticity  is  remarkable. 

The  flat  part  of  its  posterior  surface  is  remarkable. 

The  presence  of  the  inferior  recurrent  laryngeal  nerve  in 
the  groove  is  noticeable. 

The  alternating  of  incomplete  cartilaginous  rings  and  of 
fibrous  rings  is  peculiar. 

The  presence  of  transverse  muscular  fibres  posteriorly  is 
noticeable. 
Peculiarities  of  the  Extra=Pulmonary  Bronchi. 

All  the  above  remarks  apply  to  them. 

Besides,  that  the  right  bronchus  is  larger,  more  horizontal 
than  the  left,  is  remarkable. 
Peculiarities  of  the  fledium   Intra=Pulmonary  Bronchi. 

Are  peculiar  because  their  cartilaginous  rings  encircle  the 
whole  diameter  of  the  tube,  but  this  cartilage  is  broken  up 
into  several  segments. 
Peculiarities  of  the  Smaller  Intra=Pulmonary  Bronchi. 

The  cartilages  disappear  gradually. 
Peculiarities  of  the  Terminal  or  Capillary  Bronchi. 

They  possess  smooth  muscular  fibres. 

They  terminate  by  a  dilatation  which  forms  the  pulmonary 
lobules. 
Peculiarities  of  the  Lungs. 

Their  shape  is  peculiar  (like  the  supra-renal  capsules). 

Also  their  difference  in  size. 

Their  divisions  in  lobes  is  peculiar. 

The  uneven  number  of  the  lobes  is  peculiar. 

The  hilum  is  one  of  the  best  marked. 

The  large  blood  vessels  are  all  in  front  of  the  bronchi. 

The  Apex  extending  above  the  first  rib  into  the  supra- 
clavicular space  is  noticeable. 


54  THYROID  BODY. 

The  structure  is  peculiar. 

They  may  be  considered  as  compound  racemose  glands, 
the  air  vesicles  representing  the  acini. 

The  tissue  forming  them  is  noticeable ;  all  fibrous  and 
elastic. 

The  air  vesicles  are  lined  by  the  peculiar  epithelial  plates. 

It  has  two  separate  peculiar  Circulatory  Currents,  the 
Pulmonary  and  the  Bronchial. 

The  size  and  course  of  the  Pulmonary  Artery  is  remark- 
able, its  termination  unique. 

The  presence  of  four  Pulmonary  Veins  to  one  artery  is 
unique; — the  Veins  carry  red  blood. 

The  capillaries  form  three  plexuses  around  the  lobules. 

The  Bronchial  Arteries  are  remarkably  small,  because 
they  are  only  the  nutrient  arteries  and  the  lungs  being  very 
porous  contain  but  little  solids  and  these  are  formed  of  tis- 
sues requiring  but  very  little  nutrition. 

They  do  not  form  a  part  of  the  lobular  plexuses. 

The  Bronchial  Veins  open  into  the  Azygos  and  into  the 
Superior  Intercostal. 

The  Lymphatics  open  into  the  bronchial  glands  at  the 
bifurcation  of  the  trachea. 
142  Peculiarities  of  the  Pleura. 

Is  the  most  extensive  serous  membrane  next  to  the  peri- 
toneum. 

The  two  pleurae  limit  the  four  mediastina. 


ISTHMUS  OF  THE  THYROID  BODY. 

143  Shape.     The  Isthmus  is  quadrilateral. 

The  Anterior  Surface  is  in  relation  with  cervical  fascia  and 

skin. 

The   Upper   Border   gives  rise   to   the  pyramidal  process, 

which  ascends  to  the  hyoid  bone. 

The  Lower  Border  receives  the  middle  thyroid  artery  when 

it  exists. 

The  Lateral  Borders  are  continuous  with  the  lobes. 

The  Posterior  Surface  is  firmly  attached  to  the  trachea. 


LOBES  OF  THE  THYROID  BODY. 

144  Shape.     The  lobes  of  the  thyroid  body  are  conical. 

The  External  Surface  is  covered  by  the  sterno-hyoid  and 
omo-hyoid. 

The  Outer  Border  is  in  relation  with  the  carotid,  the  jugu- 
lar, the  pneumo -gastric. 

The  Inner  Border  is  attached  below  to  the  isthmus, —  but 
above  it  is  separated  from  its  fellow  by  the  trachea. 
The  Apex  is  turned  upwards. 


THYMUS — MEMBRANES  OF  THE  BRAIN.  55 

The  Base  is  turned  downwards   and    projects  beyond  the 

isthmus. 

The  Internal  Surface  is  in  relation  with  the  trachea,  the 

cricoid  and  thyroid  cartilages  and  the  recurrent  laryngeal 
nerve. 

145  Structure.  The  thyroid  body  is  composed: — 1st,  of  an 
External  or  Fibrous  Coat; — 2d,  of  a  Proper  Tissut  composed 
of  alveoles  resembling  closed  spaces  or  vesicles  lined  by  a 
single  layer  of  cells  and  filled  with  a  granular  fluid. 

4 

THYMUS. 

146  Shape.  The  thymus  consists  of  a  pair  of  unequal  lateral 
lobes,  sometimes  connected  by  a  short  isthmus. 

The  Anterior  Surface  is  in  relation  with  the  sternum. 
The    Posterior   Surface  is  in  relation  with  the  aorta,  the 
pulmonary   artery,    the  pericardium,    the   left   innominate 
vein  and  the  trachea. 

Structure.  The  thymus  is  composed: — 1st,  of  an  External 
or  Fibrous  Coat; — 2d,  of  a  Proper  Tissue  divided  into  hollow 
lobules  attached  to  a  hollow  stem; — the  walls  of  the  lobules 
are  formed  of  a  Cortical  and  a  Medullary  portion. —  Both 
portions  are  composed  of  alveoles  containing  lymphoid  ct  Us 
and  peculiar  concentric  bodies. 

147  Peculiarities  of  the  Thyroid  Body. 

Its  color  is  peculiar. 

Its  shape  also:  two  lobes  and  an  isthmus  (like  the  thy- 
mus). 

It  presents  the  peculiar  pyramidal  process. 

The  adhesion  of  the  isthmus  to  the  trachea  is  peculiar. 

Its  structure  is  peculiar,  as  presenting  closed  vesicles 
lined  by  a  single  layer  of  cells  and  filled  with  a  granular 
fluid. 

It  has  five  arteries  of  good  size. 

They  strike  the  orgau  at  the  angles. 
Peculiarities  of  the  Thymus. 

The  older  the  subject  the  smaller  the  organ. 

The  situation  is  peculiar. 

Its  irregular  shape  is  peculiar;  sometimes  it  presents  two 
lobes  united  by  a  sort  of  isthmus. 

Its  structure  is  unique:  hollow  lobules  attached  to  a  hol- 
low stem. 

However,  the  structure  of  the  walls  of  the  lobules  is  fund- 
amentally the  same  as  the  other  lymphoid  organ  (a  cavity 
is  found  also  in  the  supra-renal  capsules:  also  in  the  pitu- 
itary body;  vesicles  are  found  in  the  thyroid  body). 

MEMBRANES  OF  THE  BRAIN. 

148  Enumeration.  The  Brain  is  surrounded  by  the  Dura 
Mater,  the  Arachnoid,  the  Sub-arachnoid  Space  with  the 
Cerebro-spinal  Fluid,  and  the  Pia  Mater. 


56      CEREBRAL  DURA  MATER — ARACHNOID — PIA  MATER. 


CEREBRAL  DURA  MATER. 

149  Shape.  The  Dura  Mater  lias  the  shape  of  an  irregular  sac. 
The  External  Surface  adheres  closely  to  the  bones; — it 
presents  the  branches  of  the  middle  meningeal  artery. 

The  Internal  Surface  is  pearl-like; — it  is  lined  by  the 
arachnoid. 

It  presents  the  cerebral  falx,  the  cerebellar  falx,  the  ten- 
torium. 

It  presents  also  the  sinuses  of  the  dura  mater,  which  are 
the  superior  longitudinal,  the  inferior  longitudinal,  the 
straight,  the  posterior  occipital,  the  lateral  sinuses,  the 
anterior  occipital  or  transverse, — the  inferior  petrosal,  the 
superior  petrosal,  the  cavernous  and  the  circular. 
Structure.  The  dura  mater  is  composed: — 1st,  of  an  Ex- 
ternal layer  corresponding  to  the  periosteum; — 2d,  of  a 
Middle  purely  fibrous; — 3d,  of  an  Internal  or  Serous  layer 
corresponding  to  the  arachnoid. 

CEREBRAL  ARACHNOID. 

150  Shape.     The  Cerebral  Arachnoid  is  a  shut  sac. 

The  External  Surface,  on  the  parietal  portion,  lines  the 
dura  mater  y —  on  the  visceral  or  cerebral  portion  it  is  sepa- 
rated from  the  pia  mater  by  areolar  tissue  and  the  cerebro- 
spinal fluid  ; — it  passes  over  the  sulci  and  eminences  of  the 
brain  like  a  bridge, 

The  Internal  Surface  is  reflected  upon  itself. 
The  Cavity  of  the  Arachnoid  contains  no  fluid. 

CEREBRAL    SUB-ARACHNOID    SPACE    AND 
CEREBRO-SPINAL  FLUID. 

151  Shape.     Is  a  fluid  layer  in  which  the  brain  and  spinal  cord 
float. 

CEREBRAL   PIA  MATER. 

152  Shape.     The  Cerebral  Pia   Mater   resembles  an  irregular 
sac. 

The  External  Surface  is  in  contact  with  the  sub-arachnoid 
areolar  tissue  and  fluid. 

The  Internal  Surface  is  in  relation  with  the  cortical  sub- 
stance of  the  brain. —  It  dips  down  between  the  convolu- 
tions. 

Structure.  The  pia  mater  is  formed  essentially  of  the 
finest  capillaries,  held  together  by  very  delicate  fibres  of 
connective  tissue. 


THE  BRAIN — CEREBRUM — CALLOUS  BODY.  57 


THE  BRAIN. 

153  Enumeration.  The  Brain  comprises  the  Cerebrum,  the 
Cerebellum,  the  Varolian  Bridge  ami  tin-  Oblong  Medulla. 
The  Cerebrum  comprises  the  two  hemispheres,  the  three 
lobes,  anterior,  middle,  posterior,  the  pituitary  body,  the 
white  bodies,  the  cerebral  peduncles,  the  callous  body,  the 
fornix,  the  interposed  veil,  the  pellucid  septum,  the  ven- 
tricles, the  pineal  gland  and  the  quadrigeminal  bodies. 

CEREBRUM. 

154  Shape.     The  Cerebrum  resembles  the  half  of  an  ovoid. 
The  Upper  or  Convex  Surface  presents    the  longitudinal 

fissure  and  the  hemispheres  covered  with  convolutions. 
The  Under  Surface  or  Base  presents, — on  the  middle  Urn  . 
the  anterior  extremity  of  the  longitudinal  fissure  and  of  the 
callous  body,  the  optic  nerves,  the  pituitary  processes  and 
body,  the  white  bodies,  the  cerebral  peduncles,  the  inter- 
peduncular space,  the  posterior  perforated  space,  the  pos- 
terior extremity  of  the  callous  body,  the  posterior  extremity 
of  the  longitudinal  fissure. 

It  presents  on  the  sides  the  under  surface  of  the  hemi- 
spheres, the  olfactory  nerves,  the  anterior  perforated  space, 
the  Sylvan  fissure  enclosing  the  Island  of  Reil,  the  anterior 
or  frontal  lobe,  the  temporo-sphenoidal  lobe,  the  posterior 
or  occipital  lobe. 

The  Anterior  or  Small  Extremity  is  in  relation  with  the 
frontal  fossa. —  It  presents  the  longitudinal  fissure. 
The  Posterior  or  Large  Extremity  is  in  relation  with  the 
posterior  cerebral  fossa,  cerebral  falx  and  the  tentorium. 
Structure  of  the  Cerebrum.  The  Grey  Matter  exists  on 
the  surface  of  the  convolutions,  in  the  cavity  of  the  venl ri- 
des, and  in  the  optic  beds  and  striated  bodies. 

The  White  Matter  consists  of  longitudinal  and  transverse 
fibres. 

The  Grey  Substance  of  the  Convolutions  is  formed  of  sev- 
eral layers  of  nerve  cells  of  different  sizes  and  colors. 

The  Capillaries  are  very  abundant  in  the  grey  matter  and 
comparatively  few  in  the  white  ; —  they  present  a  character- 
istic arborescent  arrangement. 

The  Peduncles  of  the  Cerebrum  are  composed  of  three 
layers  of  longitudinal  fibres  coming  from  the  cerehellum 
and  oblong  medulla,  and  of  a  layer  of  grey  matter. 

CALLOUS  BODY. 

155  Shape.     The  Callous  Body  is  quadrilateral. 

The  Upper  Surface  is  convex  and  striated. —  It  is  free  in 
the  middle,  where  it  is  seen  as  a  bridge  connecting  the  two 
hemisphei-es. 


58  CAVITIES  OF  THE  CEREBRUM — TRIGONE  OR  FORNIX. 

The  Anterior  Border  or  Extremity  is  continuous  with  the 
optic  nerves, — it  closes  in  front  the  cavity  of  the  brain; — it 
presents  the  anterior  angles  or  horns,  which  are  prolongations 
of  the  lateral  ventricles. 

The  Posterior  Border  or  Extremity  is  free ;  it  leaves  the 
cavity  of  the  brain  open  beneath  it. —  It  presents  the  pos- 
terior angles  or  horns,  which  are  prolongations  of  the  lateral 
ventricles. 

The  Under  Surface  is  concave. —  It  adheres  to  the  trigone 
or  fornix  in  the  middle, —  on  the  sides  it  forms  the  roof  of 
the  lateral  ventricles. 

The  Lateral  Borders  pass  downwards  and  inwards  into  the 
white  substance  of  the  hemispheres. —  They  present  the 
lateral  angles  or  horns,  which  are  also  prolongations  of  the 
lateral  ventricles. 

Structure.  The  callous  body  is  composed  of  transverse 
white  fibres. 

CAVITIES  OF  THE  CEREBRUM. 

156  Boundaries  and  Divisions.  The  interior  of  the  cerebrum 
presents  a  large  cavity  bounded  below  by  the  base  of  the 
cerebrum,  above  by  the  callous  body,  and  laterally  by  the 
hemispheres. 

This  large  cavity  is  subdivided  by  two  transverse  septa, 
represented  by  the  trigone  and  interposed  veil,  into  a  lower 
story  called  the  middle  or  third  ventricle,  and  into  an  upper 
story  which  is  itself  subdivided  into  two  lateral  halves  by 
the  pellucid  septum  and  the  trigone,  called  the  two  lateral 
ventricles  of  the  cerebrum. 


TRIGONE  OR  FORNIX. 

157  Shape.  The  trigone  is  triangular  when  seen  from  above. 
The  Upper  Surface  —  in  the  middle  is  adherent  to  the  cal- 
lous body  and  pellucid  septum ; — on  the  sides  it  forms  a  part 
of  the  floor  of  the  lateral  ventricles. 

The  Borders  are  attached  to  the  interposed  veil  and  to  the 
optic  beds. 

Tho  Apex  presents  the  two  anterior  pillars  which  limit  in 
front  the  foramen  of  Monro, — they  terminate  in  the  white 
bodies,  or  corpora  albicantia. 

The  Base  presents  the  two  posterior  pillars  which  curve  for- 
ward into  the  lateral  horns. 

The  Under  Surface  is  broad  behind  and  narrow  in  front. — 
It  is  in  relation  with  the  interposed  veil  and  forms  with  it 
the  roof  of  the  middle  ventricle. 
Structure.     Is  composed  of  white  substance  throughout. 


INTERPOSED  VEIL — PELLUCID  SEPTUM — LATERAL  VENTRICLES.    59 


THE  INTERPOSED  VEIL. 

158  Shape.     The  Interposed  Veil  is  triangular. 

The  Upper  Surface  is  attached  to  the  trigone  and  forms  in 

part  the  floor  of  the  lateral  ventricles. 

The  Lateral  Borders  are  attached  to  the  optic  beds. 

The  Apex  sends  a  process  through  each  foramen  of  Monro. 

The  Base  is  continuous  with  the  pia  mater. 

The  Under  Surface  presents  the  choroid  plexus  and  the 

veins  of  Galen. 

Structure.     It  has  the  same  structure  as  the  pia  mater. 

PELLUCID  SEPTUM. 

159  Shape.     The  Pellucid  Septum  is  triangular. 

The  Lateral  Surfaces  form  the  inner  walls  of  the  lateral 
ventricles. 

The  Upper  Border  is  attached  to  the  under  surface  of  the 
callous  body. 

The  Lower  Border  is  attached  to  the  trigone. 
The  Base  is  attached  to  the  anterior  extremity  of  the  cal- 
lous body. 

The  Apex  occupies  the  angle  formed  by  the  callous  body 
and  the  trigone. 

Structure.  The  pellucid  septum  encloses  a  small  cavity 
called  the  Septal  Ventricle  or  Fifth  Ventricle, — the  inner 
walls  of  which  are  lined  with  grey  matter; — the  outer  walls 
are  formed  of  white  substance. — The  cavity  sometimes  com- 
municates with  the  middle  ventricle  by  the  Aqueduct  of  Vieus- 
sens  or  Winslow. 

LATERAL    VENTRICLES. 

160  Shape.     The  Lateral  Ventricles  are  flattened  from  above 
downwards. 

The  Upper  Wall  or  Roof  is  formed  by  the  callous  body. 
The  Lower  Wall  or  Floor  is  formed  by  the  trigone  and  the 
interposed  veil  resting  on  the  optic  beds. 
The  Inner  Wall  is  formed  behind  by  the  adhesion  of  the 
trigone  to  the  callous  body  and  in  front  by  the  pellucid  sep- 
tum. 

The  Outer  Wall  is  formed  by  the  intra- ventricular  portion 
or  nucleus  of  the  Striated  Body. —  It  gives  rise  to  the  Middh 
Horn,  which  is  the  longest  and  which  curves  forward  and 
inward  into  the  sphenoidal  lobe; — Its  floor  presents  the 
Great  Hippocampus,  presenting  along  its  inner  border  the 
fimbriated  body  and  the  dentated  band; — the  floor  presents 
also  another  small  eminence,  the  Small  Hippocampus. 
The  Anterior  Extremities  of  the  lateral  ventricles  are  the 
Anterior  Horns. 


60  MIDDLE  VENTRICLE — PINEAL  GLAND — QUADRIGEMINAL  BODIES. 

The  Posterior  Extremities  are  the  Posterior  Horns. 
Structure.     The  Striated  Bodies  are  composed  of  two  len- 
ticular nuclei  separated  by  the  diverging  fibres  of  the  cere- 
bral peduncles  ; — below  are  found  the  tonsillar  nucleus  and 
the  claustrum. 

The  Hippocampus  is  an  inverted  convolution  with  the  grey 
substance  in  the  centre. 


MIDDLE  VENTRICLE. 

161  Shape.      The  Middle  Ventricle  is  funnel-shaped  aud  flat- 
tened laterally. 

The  Upper  Surface  or  Roof  is  formed  by  the  interposed 
veil  and  trigone. 

The  Lower  Surface  or  Floor  is  formed  by  the  ehiasma,  the 
infundibulum,  the  white  bodies,  the  posterior  perforated 
space  and  the  cerebral  peduncles. 

The  Anterior  Surface  or  Wall  is  formed  by  the  callous 
body,  the  anterior  pillars  of  the  trigone  and  the  anterior 
white  commissure. 

The  Posterior  Surface  or  Wall  presents  the  orifice  of  the 
aqueduct  of  Sylvius  —  and  the  posterior  white  commissure. 
The  Lateral  Surfaces  or  Walls  are  formed  by  the  Optic 
Beds,  which  are  lined  with  grey  matter  and  present  the  grey 
commissure-, — the  anterior  tubercle, — the  posterior  tubercle 
—  and  the  internal  and  external  geniculate  bodies  —  con- 
nected with  the  quadrigeminal  bodies. 

Structure.  The  Optic  Beds  are  lined  on  their  free  surface 
by  grey  matter  and  contain  also  a  mass  of  grey  matter 
traversed  by  the  fibres  of  the  cerebellum. 


PINEAL   GLAND. 

162  Shape.     The  Pineal  Gland  is  conical. 

The  Upper  Surface  is  in  relation  with  the  pia  mater  and 

the  posterior  border  of  the  callous  body. 

The  Base  gives  attachment  to  the  peduncles  of  the  pineal 

gland. 

The  Apex  is  turned  backwards  and  is  free. 

The  Under  Surface  is  in  relation  with  the  quadrigeminal 

bodies. 

Structure.     The  pineal  gland  is  composed  chiefly  of  grey 

matter ;  it  has  a  small  cavity  often  containing  sandy  matter. 


QUADRIGEMINAL  BODIES. 

163  Shape.     The  Anterior  or  Nates  are  oblong; — the  Posterior 
or  Testes  are  hemispherical  bodies. 
The  Surfaces  are  smooth. 


CEREBELLUM — VAROLIAN  URIIN  ill.  61 

The   Internal   and    External    Extremities    are  connected 

with  the  geniculate  bodies. 

Structure.     The  quadrigeminal  bodies  arc  formed  of  white 

substance  enclosing  a  little  grey  matter. 

CEREBELLUM. 

164  Shape.  The  cerebellum  is  oblong  and  flattened  from  above 
downwards. 

The  Under  Surface  presents  laminae  and  grooves. 

It  presents  on  the  middle  line,  the  valley,  the  inferior  ver- 
miform process  with  the  nodule,  the  uvula,  pyramid,  fur- 
rowed bands,  the  valves  of  Tarini  and  the  swallow's  nest. 

It  presents  on  the  sides,  the  hemispheres,  the  posterior, 
middle  and  anterior  lobe,  the  tonsillated  lobules  and  the 
flocculus. 

The  Circumference  of  the  Cerebellum  presents  behind  a 
notch  to  receive  the  falx  —  and  on  the  sides  a  deep  hor- 
izontal fissure. 

The  Upper  Surface  presents  also  laminae  and  grooves, — 
the  superior  vermiform  process, — the  valve  of  Vieussens, — 
the  superior  peduncles  of  the  cerebellum, —  the  hemispheres 
of  the  cerebellum. 

165  Structure.  The  surface  of  the  cerebellum  is  composed  of 
grey  matter —  and  the  interior  of  white  substance  mostly. — 
However,  it  contains  in  its  interior  a  capsule  of  grey  matter 
called  the  dentated  body. — The  arrangement  of  the  grey 
matter  as  viewed  upon  a  section  is  that  of  a  tree,  the  arbor 
vitce. 

The  grey  matter  of  the  laminae  comprises  an  external  grey 
layer  of  molecular  matter, —  a  middle  layer  of  ganglionic 
cells  of  Purkinje, —  of  an  internal  rust  layer. —  a  nuclear 
layer, —  and  of  abundant  arborescent  capillaries. 

VAROLIAN  BRIDGE. 

166  Shape.  The  Varolian  Bridge  is  a  quadrilateral  white  body. 
The  Anterior  Surface  is  convex  ; —  it  presents  a  groove  for 
the  basilar  artery; — it  is  in  relation  with  the  basilar  pro- 
cess of  the  occipital  bone. 

The  Lateral  Surfaces  give  origin  to  the  middle  peduncles 

of  the  cerebellum. 

The  Upper  Surface  is  connected  with  the  cerebral  peduncles. 

The  Under  Surface  is  connected  with  the  oblong  medulla. 

The  Posterior  Surface  forms  the   upper  part   <>f  the  floor 

of  the  cerebellar  ventricle. 

Structure.     The  Varolian  Bridge  is  composed  of  alternate 

layers  of  grey  and  white  substance,  containing  vertical  and 

transverse  fibres. 


62  OBLONG  MEDULLA — VENTRICLES — EPENDYMA. 


OBLONG  MEDULLA. 

167  Shape.     The  Oblong  Medulla  is  pyramidal. 

The  Anterior  Surface  presents  the  anterior  median  fissure, 

— the  pyramidal  body, — the  olivary  body, —  the  groove  of 

origin  of  the  hypoglossal  nerve, — the  arciform  fibres  — 

and  the  lateral  tract. 

The  Lateral  Surfaces  present  the  restiform  bodies. 

The  Posterior  Surface  presents  the  lower  portion  of  the 

floor   of    the   cerebellar  ventricle, —  the  posterior    median 

fissure, —  the  posterior  pyramids. 

The  Base  is  continuous  with  the  Varolian  Bridge. 

The  Apex  is  continuous  with  the  spinal  cord. 

168  Structure.  The  Grey  Substance  of  the  oblong  medulla  is 
situated  on  the  floor  of  the  cerebellar  ventricle,  in  the  oli- 
vary bodies  and  at  the  bottom  of  the  lateral  tract. — The 
olivary  bodies  contain  a  dentated  body. 

The  White  Substance  is  composed  of  longitudinal  and  trans- 
verse fibres  and  of  the  arciform  fibres. 
The  anterior  pyramids  decussate  partially. 

CEREBELLAR  VENTRICLE. 

169  Shape.  The  Cerebellar  Ventricle,  or  Fourth  Ventricle,  is 
lozeng-eshaped. 

The  Upper  Surface  or  Roof  is  formed  above  by  the  valve 
of  Vieussens,  the  superior  peduncles  of  the  cerebellum  and 
the  under  surface  of  the  cerebellum, —  which  itself  presents 
the  nodule,  the  uvula  and  the  tonsils ; —  below  it  is  formed 
by  the  reflected  pia  mater  and  arachnoid. 
The  Anterior  Surface  or  Floor  is  formed  above  by  the  pos- 
terior surface  of  the  Varolian  Bridge  and  below  by  the  ob- 
long medulla. — It  presents  the  posterior  median  fissure, 
grey  matter,  transverse  white  fibres,  the  calamus  scriptorius. 
The  Upper  Angle  or  Extremity  presents  the  aqueduct  of 
Sylvius. 

The  Middle  or  Lateral  Angles  present  the  point  of  exit  of 
the  fibres  of  origin  of  the  auditory  nerve. 
The    Lower   Angle  or    Extremity    presents   an   opening 
formed  by  the  reflected  pia  mater  and  arachnoid. 

EPENDYMA. 

170  Definition.  The  Ependyma  is  the  delicate  transparent 
serous  membrane  lining  all  the  ventricles. 

COMMUNICATION  OF  THE  VENTRICLES. 

171  1st.  The  Septal  Ventricle  sometimes  communicates  with 
the  middle  ventricle  by  the  aqueduct  of  Vieussens ; —  the 
Middle  Ventricle  communicates  with  the  Lateral  by  the  for- 


PECULIARITIES  OF  THE  CENTRAL  ORGANS  OF  INNERVATION.      63 

amen  of  Monro  ; —  also  with  the  Cerebellar  ventricle  by  the 

aqueduct  of  Sylvius. 

2d.  The  Lateral  Ventricles  communicate  with  the  anterior 

sub-arachnoid  space  through  the  transverse  fissure  of  the 
brain ;  the  Cerebellar  communicates  with  the  posterior  sub- 
arachnoid space  through  the  opening  of  the  lower  angle. 

PECULIARITIES  OF  THE  CENTRAL  ORGANS  OF 
INNERVATION. 

172  Peculiarities  of  the  Cerebral    Dura  Mater. 

Its  pearl-like  color  is  remarkable. 

Its  shape  is  noticeable. 

Also  its  loose  adhesion  to  the  bones  of  the  vertex  and  its 
strong  attachment  to  the  bones  of  the  base. 

The  presence  of  the  large  Middle  Meningeal  Artery  is  no- 
ticeable. 

It  is  lined  by  a  serous  membrane  (like  the  pericardium). 

The  processes  called  the  falx  and  the  tentorium  are  unique. 

Also  the  numerous  venous  sinuses. 

The  sinuses  are  all  at  the  base  except  the  superior  and 
inferior  longitudinal. 

The  Cavernous  Sinus  is  traversed  by  the  internal  carotid 
and  several  nerves. 

They  communicate  with  the  extra  cranial  veins  at  several 
points. 

Its  purely  fibrous  structure,  lined  by  a  serous  membrane, 
is  noticeable. 
Peculiarities  of  the  Cerebral  Arachnoid. 

It  passes  over  the  sulci  like  a  bridge. 

It  forms  subserous  spaces. 

It  contains  no  fluid. 
Peculiarities  of  the  Cerebro=Spinal  Fluid. 

It  is  unique. 

It  is  rendered  necessary  because  the  brain  is  encased  in 
an  unyielding  bony  case ;  this  in  its  turn  is  rendered  neces- 
sary because  of  the  exposed  situation  of  the  brain. 
Peculiarities  of  the  Cerebral   Pia  Mater. 

It  is  the  analogue  of  the  periosteum  of  bones. 

It  dips  down  between  the  convolutions. 

It  penetrates  into  the  brain  and  forms  the  interposed  veil. 

Its  structure  is  remarkable. 

173  Peculiarities  of  the  Cerebrum. 

Its  grey  color  is  peculiar, —  also  the  white  .-nidi' of  most 
parts. 

Its  shape  is  unique. 

Also  the  longitudinal  fissure,  the  hemispheres,  the  con- 
volutions, the  sulci. 

Its  sylvian  fissure  and  the  division  of  each  hemisphere 
into  lobes  recalls  that  of  the  lungs. 


64  PECULIARITIES  OF  THE  CENTRAL  ORGANS  OF  INNERVATION. 

Its  base  is  the  most  important  and  noticeable  part,  be- 
cause there  we  find  the  peculiarities  and  the  large  nerves 
and  vessels. 

The  Island  of  Reil,  at  the  bottom  of  the  sylvian  fissure, 
is  unique. 

The  presence  of  the  large  Ganglionic  Cells  of  Purkinje 
are  peculiar. 

The  Arteries  form  the  Circle  of  Willis  and  are  found  at 
the  base. 

No  large  arteries  penetrate  its  tissue  :  they  first  break  up 
in  the  pia  mater. 

The  Veins  of  the  surface  discharge  into  the  Superior 
Longitudinal  Sinus. 

Those  of  the  interior  into  the  Straight  Sinus. 

The  Capillaries  of  the  convolutions  present  a  character- 
istic arborescent  arrangement. 

Peculiarities  of   the    Peduncles    of  the  Cerebrum:    are 
unique. 
Peculiarities  of  the  Callous  Body:  are  unique. 

However,  it  may  be  considered  as  an  isthmus  joining  two 
lobes. 

The  absence  of  grey  matter  in  its  substance  is  noticeable. 

174  The  Peculiarities  of  the  Cavities  of  the  Cerebrum. 

They  correspond  to  those  of  the  heart. 

The  communication  with  the  surface  is  through  the  trans- 
verse fissure. 

This  transverse  fissure  is  the  only  opening. 

The  presence  in  these  cavities  of  masses  of  grey  matter 
(the  striated  bodies  and  the  optic  beds)  is  remarkable. 

The  separation  of  these  cavities  by  the  trigone,  the  inter- 
posed veil,  the  pellucid  septum  is  unique. 

The  presence  of  a  cavity  in  the  septum  is  unique. 

The  lateral  Horns  of  the  Lateral  Ventricles  winding 
around  the  peduncles  are  noticeable. 

175  Peculiarities  of  the  Pineal  Gland. 

It  is  unique. 

Its  cavity  containing  sandy  matter  is  unique. 
Peculiarities  of  the  Quadrigeminal  Bodies. 

They  are  also  unique. 

Their  connection  with  the  optic  beds  is  noticeable. 
Peculiarities  of  the  Cerebellum. 

Its  size  is  remarkable. 

Its  color  also. 

Also  its  peculiar  shape. 

Also  some  of  its  peculiarities :  specially  the  valves  of 
Tarin,  the  swallow's  nest,  the  peduncles,  the  valve  of 
Vieussens. 

The  lamella?  replacing  here  the  convolutions  are  notice- 
able. 

They  have  the  same  structure  and  the  same  capillaries  as 
the  convolutions. 


SPINAL  CORD.  (J.-. 

The  presence  of  the  Arbor  Vitae  aud  of  the  dentated  body 
is  peculiar. 

Peculiarities  of  the  Varolian  Bridge. 

It  is  unique. 

Its  situation  at  the  junction  of  the  other  parts  of  the  brain 
which  it  unites  is  remarkable. 
Its  white  color  is  noticeable. 

The  direction  of  its  fibres  in  its  substance  is  noticeable. 
The  large  Basilar  artery  resting  on  it  is  to  be  noted. 

Peculiarities  of  the  Oblong  Medulla. 

Its  white  color  is  peculiar  (like  varolian  bridge,  cerebral 
peduncles). 

Its  size,  the  smallest  of  all  the  parts  of  the  brain,  is  to  be 
noted. 

The  origin  from  it  of  numerous  most  important  nerves  is 
noticeable. 

The  decussation  of  its  fibres  is  unique. 

Peculiarities  of  the  Cerebellar  Ventricle. 

Its  situation  between  the  Varolian  Bridge  and  the  Oblong 
Medulla  is  peculiar. 
Its  size  also  is  peculiar. 
Its  shape,  lozenge- shape,  is  remarkable. 
The  presence  of  grey  matter  on  its  floor  is  noticeable. 
Also  the  origin  there  of  the  auditory  nerves. 

176    The  Communication  of  the  Ventricles. 

They  communicate  between  themselves  and  with  the  ex- 
terior of  the  brain,  through  the  Aqueduct  of  Winslow.  the 
foramen  of  Monro,  the  Aqueduct  of  Vieussens,  the  Trans- 
verse Fissure  of  the  brain  and  the  lower  angle  of  the  cerebel- 
lar ventricle. 

MEMBRANES  OF  THE  SPINAL  CORD. 

177  Enumeration.  The  envelopes  of  the  spinal  cord  are  the 
Dura  Mater,  the  Arachnoid,  the  Cerebro-spinal  Fluid  and 
the  Pia  Mater. 


DURA  MATER  OF  THE  SPINAL  CORD. 

178  Shape.     The  dura  mater  of  the  spinal  cord  has  the  shape 
of  a  long  tube. 

The  External  Surface  is  unattached  to  the  periosteum. — 
It  gives  attachment  to  the  dentated  lif/aiin  »f  of  the  cord. 
The   Upper   Extremity   is  attached  to    the  occipital  fora- 
men. 

The    Lower  Extremity  is    closed  and  is    attached    to   the 
sacrum. 
Structure.     It  is  composed  of  simple  fibrous  tissue 

5 


66  CEREBROSPINAL  FLUID — SPINAL  CORD. 


ARACHNOID  OF  THE  SPINAL  CORD. 

179  Shape.     The  arachnoid  of  the  cord  resembles  a  long  double 
tube. 

The  External  Surface  lines  the  dura  mater  and  is  then  re- 
flected upon  the  cord. 

The  Internal  Surface  is  reflected  upon  itself. 
The   Upper    Extremity   is   continuous   with  the   cerebral 
arachnoid. 

The    Lower   Extremity  forms  a  closed  bag   around  the 
mare's  tail. 
Structure.     It  is  a  purely  serous  membrane. 

CEREBRO-SPINAL  FLUID. 

180  The  Cerebro=spinal  Fluid  forms  a  regular  layer  around 
the  cord,  specially  during  the  arterial  diastole  of  the  brain. 

PIA  MATER  OF  THE  SPINAL  CORD. 

181  Shape.     The  Pia  Mater  of  the  spinal  cord  has  the  shape  of 
a  tube. 

The  External  Surface  gives  off  the  dentated  ligament  to  the 

dura  mater  —  and  sends  off  a  prolongation  or  sheath  around 

each  nerve. —  It  is  in  relation  with  the  sub-arachnoid  areolar 

tissue  and  the  cerebro-spinal  fluid. 

The  Internal  Surface  adheres  intimately  to  the  cord,  which 

seems  compressed  by  it. 

The  Upper  Extremity  is  continuous  with  the  pia  mater  of 

the  brain. 

The  Lower  Extremity   presents  the  coccygeian  ligament. 

Structure.     It  is  more  fibrous  and  less  vascular  than  the 

cerebral  pia  mater. 

SPINAL  CORD. 

182  Shape.     The  Spinal  Cord  is  cylindrical  with  a  cervical  and 
a  lumbar  enlargement. 

The  Posterior  Surface  presents  the  posterior  median  As- 
sure,—  the  posterior  white  commissure, —  the  posterior  col- 
umns (or  postero-lateral  columns). 

The  Lateral  Surfaces  present  the  antero-lateral  fissure, — 
the  lateral  columns, —  the  postero-lateral  fissure. 
The  Upper  Extremity  is  continuous  with  the  oblong  me- 
dulla— it  presents  the  neck; — it  corresponds  to  the  occipi- 
tal foramen. 

The  Lower  Extremity  is  pointed ; — it  gives  attachment  to 
the  caudal  ligament. 

The  Anterior  Surface  presents  the  anterior  median  fis- 
sure,—  the  anterior  white  commissure, —  the  anterior  col- 
umns of  the  spinal  cord. 


NOSE.  67 

183  Stiucture.     The  spinal    cord    is   composed    externally    of 
white  substance. 

Internally,  of  grey  substance,  having-  the  shape  of  two  cres- 
cents united  by  a  transverse  grey  band; — the  extremities  of 
the  crescents  are  called  the  horns  and  correspond  to  the  ori- 
gin of  the  nerves  ; —  the  anterior  horns  have  large  multipolar 
cells  —  and  the  posterior  horns  small  multipolar  cells  ; — the 
processes  all  communicate  with  one  another  and  with  the 
fibres  of  the  white  substance. 

184  Peculiarities  of  the  Dura  Mater  of  the  Spinal  Cord. 

Its  shape  is  peculiar — that  of  a  long  tube. 

It  is  unattached  to  the  bones  except  at  the  foramens. 

It  presents  the  peculiar  dentated  ligament. 
Peculiarities  of  the  Arachnoid  of  the  Spinal  Cord. 

Its  shape  is  peculiar ;  that  of  a  long  tube. 

It  forms  a  closed  bag  around  the  mare's  tail. 
Peculiarities  of  the  Cerebro=Spinal  Fluid. 

Is  only  present  during  the  arterial  diastole  of  the  brain. 
Peculiarities  of  the  Pia  Mater  of  the  Spinal  Cord. 

Its  shape  is  peculiar. 

It  presents  the  dentated  ligament  and  the  caudate  liga- 
ment. 

It  seems  to  constrict  the  cord. 

It  is  more  fibrous  and  less  vascular. 

185  Peculiarities  of  the  Spinal  Cord. 

It  is  unique. 

Its  color  is  peculiar. 

Its  length  also;  it  stops  at  the  second  lumbar  vertebra. 

Its  shape  is  peculiar. 

Its  grooves  and  fissures  are  peculiar, —  specially  the 
respiratory  tract  in  the  cervical  region. 

The  presence  of  the  Caudate  Ligament  is  peculiar. 

Its  structure  is  unique. 

The  White  matter  is  on  the  outside. 

The  Grey  matter  is  in  the  interior  and  forms  two  crescents 
joined  by  a  transverse  band. 

The  arrangement  of  the  nerve  cells  is  peculiar. 

No  large  artery  penetrates  its  substance. 

The  Capillaries  are  characteristic. 

NOSE. 

186  Shape.     The  nose  is  a  pyramidal  eminence. 

The  Anterior  Border  is  called  the  bri<l<j<}  between  the  eyes. 

and  below  the  hark. 

The  Lateral  Surfaces  are  inclined  outwards. 

The  Lateral  Borders  are  separated  from  the  cheek  by  the 

naso-orbital  groove. 

The    Upper    Extremity    is    the    Root. 


68  NASAL  CAVITIES. 

The  Lower  Extremity  presents  the  tip  or  lobule, — the 
wings, —  the  nostrils, —  and  the  column  or  septum  of  the 
nose. 

The  Posterior  Surface  is  concave — and  is  turned  towards 
the  nasal  cavities  ; —  it  gives  attachment  to  the  septal  carti- 
lage and  ethmoidal  plate. 

187  Structure.  The  Nose  is  composed: — 1st,  of  Skin; — 2d,  of 
Muscles,  which  are  the  pyramidal,  the  common  elevator  of 
the  wing  of  the  nose  and  of  the  upper  lip,  the  nasal  com- 
pressor or  sphincter,  the  nasal  dilator  or  transverse  ; — 3d, 
of  Cartilages,  which  are  the  septal,  the  upper  lateral,  the 
lower  lateral,  the  ascending ; —  4th,  of  a  Fibrous  Membrane 
binding  the  cartilages  together ; —  5th,  of  Bones,  which  are 
the  nasal  bones  and  ascending  branch  or  nasal  process  of 
the  upper  maxilla; — 6th,  of  Mucous  Membrane. 

NASAL  CAVITIES. 

188  Shape.  The  nasal  cavities  are  prismatic  and  triangular. 
The  Inner  Surface  or  Wall  forms  the  nasal  partition; — 
It  is  formed  by  the  triangular  cartilage,  vomer  and  ethmoid. 
The  Outer  Surface  or  Wall  presents  a  flat  surface, — the 
superior  turbinated  bone, —  the  superior  meatus, — the  mid- 
dle turbinated  bone, —  the  middle  meatus  with  the  opening 
of  the  antrum, — the  inferior  turbinated  bone- — and  the  in- 
ferior meatus,  with  the  orifice  of  the  nasal  canal  and  the 
Eustachian  tube. 

The  Lower  Surface  or  Floor  is  formed  by  the  maxillary 

and  the  palate  bones. 

The  Upper  Surface  or  Roof  is   formed  by  the  cribriform 

plate. 

The  Anterior  Extremity  is  formed  by  the  anterior  nares. 

The  Posterior  Extremity  is  formed  by  the  posterior  nares. 

189  Structure.  The  Mucous  Membrane  of  the  Nasal  Cavities,  or 
membrane  of  Schneider,  lines  all  the  structures; — it  has  a 
ciliated  epithelium  and  racemose  glands. 

The  filaments  of  the  olfactory  nerve  do  not  extend  below  the 
superior  turbinated  bone  ; — they  terminate  in  the  olfactory 
cells,  which  are  connected  deeply  with  the  axis  cylinder  of 
the  nervous  filaments  and  which  give  off  towards  the  sur- 
face two  or  three  fibrils  which  terminate  in  the  epithelium. 

190  Peculiarities  of  the  Nose. 

It  is  unique. 

The  nostrils  are  peculiar,  being  lined  with  skin. 

The  cartilaginous  parts  are  noticeable. 

There  are  no  intermediate  capillaries  at  the  tip. 
Peculiarities  of  the  Nasal  Cavities. 

Their  irregularity  is  peculiar. 

Their  communication  with  all  the  other  cavities  of  the  head 
is  noticeable. 


EYEBALL — COHNKA — SCLEROTIC.  69 

The  epithelium  of  the  mucous  membrane  is  ciliated. 

The  Veins  anastomose  with  the  superior  longitudinal  sinus 
through  the  blind  foramen. 

It  receives  a  nerve  of  special  sense  whose  fibrils  termi 
nate  by  hair  cells. 

EYEBALL. 

191  Enumeration.  The  Eyeball  consists  of  the  Cornea, 
Sclerotic,  Choroid,  Retina,  Vitreous  Body,  Crystalline  Lens, 
Iris,  and  Acpieous  Humor. 


CORNEA. 

Shape.  The  Cornea  is  the  segment  of  a  sphere  smaller  than 
that  of  the  sclerotic. 

The  Anterior  Surface  is  convex; — it  is  in  relation  with 
the  lids. 

The  Circumference  seems  beveled,  so  that  it  looks  ellipti- 
cal in  front  and  circular  behind. 

The  Posterior  Surface  is  concave; — it  is  in  relation  with 
the  aqueous  humor. 

Structure.  The  cornea  is  composed  : —  1st,  of  a  Laminated 
Epithelial  layer ; — 2d,  of  an  Anterior  Thin  Elastic  Lamina; 

—  3d,  of  Fibres  continuous  with  those  of  the  sclerotic,  but 
forming  lamellas  and  alveoles  containing  fluid  and  the 
corneal  corpuscles  ; — 4th,  of  &  Posterior  Thirl-  Mastic  Lam- 
ina, forming  at  the  margin  the  pectinate  ligament  of  the 
iris; — 5th,  of  a,  Posterior  Single  Layer  of  Endothelial  Cells; 

—  6th,  it  is  deprived  of  blood  vessels  except  at  the  margin. 


SCLEROTIC. 

194  Shape.     The  Sclerotic  corresponds  to  about  the  four-fifths 
of  a  regular  sphere. 

The  External  Surface  is  white; — it  is  in  relation  in  front 
with  the  conjunctiva  and  the  tendons  of  the  straight  mus- 
cles ;  in  the  middle  with  the  four  vorticose  veins  ;  behind  with 
Tenon's  capsule  and  the  tendons  of  the  two  obliques. 
The  Internal  Surface  is  brown: — it  is  in  relation  with  the 
choroid. 

The  Anterior  Extremity  is  continuous  with  the  cornea. 
The  Posterior  Extremity  presents  an  orifice  with  a  cribri- 
form membrane,  through  which  the  optic  nerve  is  sifted,  as 
it  were. 

Structure.     The  sclerotic  is  purely  Fibrous,  with  numerous 
branching  connective  tissue  corpuscles. 


70  CHOROID — RETINA — VITREOUS  BODY. 


CHOROID. 

195  Shape.  The  Choroid  represents  the  segment  of  a  sphere 
with  the  concavity  turned  forward. 

The  External  Surface  is  of  a  light  brown ; — it  presents 
grooves  for  the  vessels  and  nerves; — it  is  in  relation  with 
the  sclerotic. 

The  Internal  Surface  is  of  a  deep  brown; — it  is  loosely- 
attached  to  the  retina. 

The  Anterior  Extremity  presents: — 1st,  the  choroid  zone, 
which  is  deeper  in  color,  is  serrated  and  corresponds  to  the 
zone  of  Zinn; — 2d,  the  ciliary  ligament; — 3d,  the  ciliary 
processes. 
The  Posterior  Extremity  is  perforated  by  the  optic  nerve. 

196  Structure.  The  choroid  is  composed: — 1st,  of  an  External 
Layer  of  connective  tissue  with  irregular  caudate  pigment 
cells; — 2d,  of  a  Venous  Layer  presenting  vorticose  capil- 
laries ; — 3d,  of  an  Arterial  and  Nervous  Layer  formed  by  the 
large  ciliary  arteries  and  by  the  ciliary  nerves; — 4th,  of  a 
Capillary  Layer  or  membrane  of  Ruysch,  presenting  char- 
acteristic radiating  anastomoses; — 5th,  of  a  Vitreous  Mem- 
brane separating  it  from  the  retina. 

RETINA. 

197  Shape.  The  Retina  resembles  a  segment  of  a  sphere  with 
the  concavity  turned  forward. 

The  External  Surface  is  in  mere  contact  with  the  choroid. 

The  Anterior   Extremity  is  serrated  and  adheres  to  the 

posterior  border  of  the  zone  of  Zinn. 

The  Posterior    Extremity   is   continuous    with  the   optic 

nerve. 

The  Internal  Surface   presents  the  transverse  fold, —  the 

yellow  spot, —  the  blind  foramen  —  and  the  papilla  of  the 

optic  nerve,  with  the  central  artery  and  vein  of  the  retina. 

198  Structure.  The  retina  is  composed: — 1st,  of  a  Stroma 
forming  the  fibres  of  Muller; — 2d,  of  a  Pigmentary  layer; 
— 3d,  of  an  External  Limiting  Membrane; — 4th,  of  the  Layer 
of  Rods  and  Cones; — 5th,  of  the  Outer  Nuclear  layer; — 6th, 
of  the  Outer  Granular  layer; — 7th,  of  the  Inner  Nuclear 
layer; — 8th,  of  the  Inner  Granular  layer; — 9th,  of  the 
Layer  of  Ganglionic  Cells; — 10th,  of  the  Layer  of  the  Optic 
Nerve  Fibres. 

At  the  yellow  spot,  the  cones  are  few,  the  rods  plentiful 
and  large,  the  ganglionic  cells  form  several  layers. 

VITREOUS  BODY. 

199  Shape.     The  vitreous  body  has  the  shape  of  a  spheroid. 
The  Anterior  Surface  receives  the  lens. 

It  presents  the  Zone  of  Zinn,   which  corresponds  to  the 


CRYSTALLINE  LENS — IBIS.  71 

choroid  zone  and  to  the  ciliary  processes  of  the  choroid. — 
The  zone  of  Zinn  divides  into  an  anterior  fine  membrane 
attached  to  the  anterior  margin  of  the  lens  mid  ;i  posterior 
fine  membrane  attached  to  the  posterior  margin. — Between 
the  two  membranes  is  the  beaded  canal. 

The  Posterior  Surface  presents  depressions   for  the  folds 
of  the  yellow  spot  and  for  the  papilla  of  the  optic  nerve. 
The  Middle  Surface  is  in  relation  with  the  retina,  but  is 
not  adherent  to  it. 

Structure.  The  vitreous  body  is  composed  of  an  external 
or  Hyaloid  Membrane  and.  of  alveoles  in  which  the  Vitreous 
Humor  is  deposited. 

CRYSTALLINE  LENS. 

200  Shape.     The  Crystalline  Lens  is  biconvex. 

The  Anterior  Surface  is  less  convex  than  the  posterior. 
It  is  in  relation  with  the  pupil  and  with  the  iris. 
The  Posterior  Surface  is  the  more  convex; — it  is  in  re- 
lation with  the  fossa  on  the  vitreous  body. 
The  Circumference  is  in  relation  by  its  anterior  lip  with  the 
ciliary  processes  of  the  choroid,  the  zone  of  Zinn,  the  ciliary 
muscle,  the  point  of  union  of  the  sclerotic,  cornea  and  cir- 
cular  sinus; — by   its   interstice  with    the  beaded  canal; — 
by  the  posterior  Up  with  the  hyaloid  membrane. 

201  Structure.  The  crystalline  lens  are  composed: — 1st,  of  a 
Capsule; — 2d,  of  the  Liquid  of  Morgagni; — 3d,  of  a  Corti- 
cal and  —  4th  of  a  Central  Portion  or  Nucleus. — Both  por- 
tions are  composed  of  hexagonal  fibres  or  tobes  which  form 
lamiua?  separated  by  clear  spaces  called  Meridians,  and  filled 
with  homogeneous  substance. 


IRIS. 

202  Shape.  The  Iris  has  the  shape  of  a  circular  diaphragm, 
with  an  opening  in  the  centre  called  the  pupil. 

The  Anterior  Surface  varies  in  color  and  presents  a  small 
and  a  large  colored  ring. —  It  presents  also  white  or  fibrous 
arcades  and  striae. — It  forms  the  posterior  wall  of  the  ante- 
rior chamber. 

The  Posterior  Surface  is  of  a  jet  black. — It  forms  the 
anterior  wall  of  the  posterior  chamber. 

The  Greater  Circumference  is  in  relation  with  the  pecti- 
nate Ligament  of  the  iris,  the  ciliary  muscle  and  the  ciliary 
processes  of  the  choroid. 

The  Small  Circumference  of  Pupil  is  circular  and  ser- 
rated. 

203  Structure.  The  Iris  is  composed: — 1st,  of  an  Anterior 
Serous  Layer; — 2d,  of  an  Anterior  Basement  Membrane; — 
3d,  of  a  Proper  Tissue  composed  of  connective   tissue  with 


72     AQUEOUS  HUMOR — ORBITAL  FASCIA — MUSCLES  OF  EYEBALL. 

pigmented  corpuscles,  of  circular  and  radiating  fibres ; — 
4th,  of  &  Posterior  Basement  Membrane; — 5th,  of  &  Pigmen- 
tary Layer; — 6th,  of  a  Posterior  Serous  Layer; — 7th,  of 
Arterial  Capillaries  forming  a  marginal  and  pupillary  plexus  ; 

—  8th,  of  Capillary  Veins  which  open  into  the  circular  sinus 
situated  at  the  point  of  union  of  the  iris  with  the  cornea 
and  sclerotic. 

AQUEOUS  HUMOR. 

204  Shape.  The  Aqueous  Humor  is  enclosed  in  a  shut  sac 
called  the  membrane  of  the  aqueous  humor  or  membrane  of 
Descemet. —  It  is  divided  by  the  iris  into  an  anterior  and  a 
posterior  chamber.     * 

The  External  Surface  of  the  membrane  is  firmly  attached 
to  the  cornea,  iris  and  lens. — It  may  be  considered  as  form- 
ing the  posterior  elastic  lamina  of  the  cornea,  the  anterior 
and  posterior  basement  membranes  of  the  iris  and  the  ante- 
rior capsule  of  the  lens. 

The  Internal  Surface  is  lined  with  a  single  layer  of  poly- 
gonal cells. 

The  Liquid  or  Humor  itself  is  remarkable  for  its  clearness 
and  the  rapidity  of  its  reproduction. 

ORBITAL  FASCIA. 

205  Divisions.  The  orbital  fascia  is  composed: — 1st,  of  a 
Palpebral  portion,  which  corresponds  to  the  lids; — 2d,  of  a 
Parietal  portion,  which  lines  the  walls  of  the  orbit; — 3d,  of  a 
Muscular  portion,  which  forms  sheaths  around  the  muscles ; 

—  and  4th,  of  an  Ocular  portion,  which  is  reflected  behind 
the  eyeball  and  forms  Tenon's  capsule. 

MUSCLES  OF  THE  EYEBALL. 

206  The  Muscles  of  the  Eyeball  are  —  the  Upper  Straight  or 
elevator, —  the  Lower  Straight  or  depressor, —  the  Internal 
Straight  or  adductor, —  the  External  Straight  or  abductor, — 
the  Superior  Oblique,  which  turns  the  pupil  outwards  and 
downwards; — and  the  Inferior  Oblique  or  sympathetic 
muscle,  which  turns  the  pupil  outwards  but  upwards. 

All  the  straight  muscles  originate  from  the  optic  foramen 
and  sphenoidal  fissure  and  are  inserted  into  the  anterior 
segment  of  the  sclerotic. 

The  Superior  Oblique  originates  from  the  sphenoidal 
fissure  —  and  the  Inferior  Oblique  from  the  orbital  margin ; 
both  are  inserted  into  the  outer  part  of  the  posterior  seg- 
ment of  the  sclerotic. 

All  the  muscles  are  supplied  by  the  Common  Ocular 
Motor,  except  the   External   Straight,  which   receives  the 


EYELIDS — EYEBROWS — LACHRYMAL  APPARATUS.        l'-> 

External   Ocular  Motor  or  sixth  nerve,  and  the  Superior 
Oblique,  which  receives  the  pathetic  or  fourth  nerve. 

EYELIDS. 

207  Structure.  The  Eyelids  are  composed: — 1st,  of  a  Cu- 
taneous layer; — 2d,  of  a  Muscular  layer  formed  by  the  orbic- 
ular;—  3d,  of  a  Fibro-Cartilaginous  layer  formed  by  the 
two  tarsal  cartilages  and  the  broad  ligament; — 4th,  of  a 

,  Tendinous  Layer  in  the  upper  lid  only,  formed  by  the  ex- 
panded tendon  of  the  elevator  muscle  of  the  upper  lid ; — 
5th,  of  a  Mucous  Layer  or  conjunctiva  forming  the  carun- 
cula,  the  semilunar  folds  and  the  lachrymal  lake; — 6th,  of 
Glands  which  are  the  glands  of  the  skin  (sweat  and  seba- 
ceous), the  glands  of  the  free  margin  (which  are  the  ciliary 
glands  on  the  anterior  lip  and  the  Meibomian  glands  on  the 
posterior  lip  and  the  caruncula), —  the  glands  of  the  con- 
junctiva, which  are  simple  racemose  glands. 

EYEBROWS. 

208  Structure.  The  Eyebrows  are  formed: — 1st,  of  Hairs  ; — 
2d,  of  Skin; — 3d,  of  the  Superciliary  Muscle; — 4th,  of  the 
Superciliary  Eminence  of  the  Frontal  Bone. 

LACHRYMAL  APPARATUS. 

209  Enumeration.  The  tears  are  secreted  by  the  Lachrymal 
Glands,  situated  in  the  upper  and  outer  part  of  the  orbit  and 
lid; — they  are  discharged  through  fine  Excretory  Darts  on 
the  outer  part  of  the  upper  eyelid. 

The  Orbicular  Muscle  spreads  them  over  the  cornea,  and 
at  the  same  time  directs  them  towards  the  Lachrymal  Lake 
at  the  internal  angle  of  the  eye. 

They  are  absorbed  there  by  the  Lachrymal  Points, — and 
conducted  into  the  Lachrymal  Canals,  which  are  situated  in 
the  substance  of  the  two  direct  tendons  of  the  orbicular. — 
They  are  then  discharged  into  the  Lachrymal  Sac,  the  outer 
wall  of  which  is  membranous, —  and  then  into  the  Nasal 
.Canal  and  the  Inferior  Meatus. 

210  Peculiarities  of  the  Eyeball  and   Envelopes. 

Is  unique. 
Peculiarities  of  the  Cornea. 

Is  irregular. 

Its  continuation  with  the  sclerotic  is  unique. 

The  presence  of  the  Elastic  Laminae  is  peculiar. 

The  Corpuscles  are  noticeable  (like  bone,  cement,  tendon. 
connective  tissue). 

The  fluid  between  the  meshes  is  remarkable  (like  the  vit- 
reous body). 

The  absence  of  capillaries  is  remarkable. 


74  LACHRYMAL  APPARATUS. 

Peculiarities  of  the  Sclerotic. 

It  is  peculiar  for  its  color  (like  the  albugineons  of  testicle). 

Also  its  shape  (like  a  shell). 

The  insertion  of  muscles  to  it  is  unique. 

The  perforations  for  the  vorticose  veins  are  unique. 

The  perforation  for  the  optic  nerve  also. 

Its  continuation  with  the  cornea  is  unique. 

The  brown  color  of  the  inner  surface  is  unique. 

Its  unyielding  structure  is  remarkable. 
Peculiarities  of  the  Choroid. 

It  is  peculiar  for  its  color  (like  the  iris). 

Also  for  presenting  the  choroid  zone. 

Also  the  ciliary  Processes". 

Also  the  ciliary  ligament. 

Its  clean  cut  perforation  by  the  optic  nerve  is  noticeable. 

The  difference  in  the  outer  and  inner  pigment  cells  is  re- 
markable. 

Its  great  vascular  structure  is  rare  (like  the  iris). 

The    Arteries    are    the    very   numerous   posterior  short 
ciliaries. 

The  Veins  form  the  peculiar  unique  Vorticose  Veins. 

The  Capillaries  form  a  special  membrane,  the   membrane 
of  Ruysch,  whose  vessels  are  stellate. 

The  Nerves  are  abundant. 
Peculiarities  of  the  Retina. 

It  is  peculiar  by  its  color  in  the  dead. 

Also  its  thorough  transparency  in  the  living. 

Its  thinness  is  noticeable. 

Its  anterior  serrated  extremity  is  unique. 

Its  continuation  behind  with  the  optic  nerve  is  unique. 

Also  the  optic  papilla  with  the  vessels  emerging  from  it. 

Also  the  transverse  fold  and  the  yellow  spot. 

Also  the  numerous  layers,  specially  considering  the  thin- 
ness of  the  membrane. 

The  Stroma  is  peculiar  and  unique  (like  the  spinal  cord). 

Also  its  pigmentary  layer  (as  in  the  choroid). 

Also  its  limiting  membranes  (as  in  dermis  and  cornea). 

Also  its  layers  of  Rods  and  Cones,  unique. 

Also  the  nuclear  layers  (as  in  cerebellum). 

Also  the  Ganglionic  Cells. 

Also  the  layers  of  the  Optic  Nerve  Fibres. 

The  Central  Artery  and  Veins  are  unique. 

211  Peculiarities  of  the  Vitreous  Body. 

It  is  unique  (it  recalls  the  cornea). 
Its  consistency  is  unique. 
The  Zone  of  Zinn  is  peculiar. 
Also  the  Beaded  Canal. 

Also  its  structure  recalling  the  Cornea  and  the  tissue  of 
the  umbilical  cord. 

Also  the  absence  of  vessels  in  the  adult. 


PECULIARITIES  OF  TDK  APPENDAGES  OF  THE  BYE.  75 

Peculiarities  of  the  Crystalline    Lens. 

It  is  unique. 

Also  is  its  shape. 

Also  numerous  and  important  organs  near  its  circum- 
ference. 

Its  structure  is  unique. 

Its  capsule  is  unique. 

Its  fibres  are  unique. 

Its  meridians  are  unique. 

The  central  portion  is  the  harder,  whereas  usually  it  is 
the  softer. 

The  absence  of  nerves  and  vessels  is  peculiar. 
Peculiarities  of  the  Iris. 

It  is  a  unique  organ. 

The  variation  of  color  of  the  anterior  surface  is  unique. 

The  permanence  of  color  of  the  posterior  surface  is  no- 
ticeable, 

The  pupil  is  unique. 

The  muscular  fibres  are  peculiar. 

The  Arteries  are  numerous  ;  long  ciliary,  anterior  short 
ciliary. 

The  Veins  open  in  the  peculiar  circular  sinus. 

The  Capillaries  form  two  rings. 

The  Nerves  come  from  a  ganglion,  the  ophthalmic 

Peculiarities  of  the  Aqueous  Humor. 

It  is  unique — (resembles  the  endolymphs,  the  cerebro- 
spinal fluid). 

The  rapidity  of  its  reproduction  is  unique  (as  the  cerebro- 
spinal fluid). 

PECULIARITIES  OF  THE  APPENDAGES  OF  THE  EYE. 

212  Peculiarities  of  the  Orbital  Fascia. 

Is  unique  as  an  apparatus  of  suspension. 
Tenon's  Capsule  is  peculiar. 

Peculiarities  of  the  fluscles  of  the  Eyeball. 

They  are  peculiar  because  all  (excepting  one)  originate 
from  the  same  spot. 

The  Four  Straight  are  peculiar  because  they  are  inserted 
in  the  anterior  segment  regularly  around  the  cornea. 

The  Two  Oblique  are  peculiar  in  being  inserted  on  tin'' 
posterior  segment  and  on  its  outer  part. 

The  Great  Oblique  is  noticeable  because  it  is  the  only 
muscle  reflected  through  a  regular  pulley. 

The  Small  Oblique  is  peculiar  in  being  coiled  as  it  were 
around  the  eyeball. 

The  Nerves  of  these  Muscles  arc  peculiar  in  their  distri- 
bution. 

The  filaments  to  the  iris  are  peculiar. 


76  ORGANS  OF  HEARING — PAVILION  OR  AURICLE. 

Peculiarities  of  the  Eyelids. 

Are  unique. 

Their   skin   is  remarkable   for  its   thinness   (as   in  the 
penis). 

The  Tarsal  Cartilages  are  unique. 

The  Broad  Ligament  is  unique,  dividing  the  lids  into  two 
distinct  layers  (like  Tenon's  Capsule). 

The  termination  of  the  Tendon  of  the  Elevator  Muscle  of 
the  Eyelid  is  unique. 

The  Mucous  Layer  is   peculiar  in  forming  the  semilunar 
fold  and  the  lachrymal  lake. 

The  Caruncula  is  unique. 

The    Meibomian    Glands   are   peculiar   (like    the   Ceru- 
minous). 

The  Veins  behind  the  broad  ligament  form  the  Ophthal- 
mic vein. 

The  Veins  in  front  form  the  facial  vein. 

The  Lymphatics  behind  discharge  into  the  deep  glands. 

Those  in   front  into  the  parotid  and   the  submaxillary 
glands. 
Peculiarities  of  the  Eyebrows. 

Are  unique. 
Peculiarities  of  the  Lachrymal  Apparatus. 

Is  also  unique. 

The  Gland  has  two  portions. 

The  Excretory  ducts  are  multiple  (as  in  the  sublingual, 
prostate). 

The  Lachrymal  Lake  is  unique. 

Also  the  Lachrymal  Points. 

Also  the  Lachrymal  Ducts. 

The  Lachrymal  Sac  is  noticeable  (like  the  gall  bladder, 
urinary  bladder,  seminal  vesicles). 

The  Nasal  Canal  is  remarkable. 

The  purely  mechanical  uses  of  the  secretions  is  notice- 
able. 

ORGANS  OF  HEARING. 

213  Enumeration.  The  organs  of  hearing  are  composed  of  the 
External  Ear,  comprising  : — 1st.  the  Pavilion  and  External 
Auditory  Canal ; — 2d,  the  Middle  Ear,  comprising  the  tym- 
panum and  the  Chain  of  Ossicles,  the  Mastoid  Cells  and  the 
Eustachian  Tube; — 3d,  the  Internal  Ear,  comprising  the 
Vestibule,  the  Semi-circular  Canals  and  Cochlea,  each  hav- 
ing a  bony,  a  membranous  and  a  liquid  portion; — 4th,  the 
Internal  Auditory  Canal  lodging  the  Auditory  Nerve. 

PAVILION  OR  AURICLE. 

214  Shape.  The  pavilion  is  oval; — it  resembles  the  expanded 
end  of  a  trumpet  crushed  inwardly. 

The  Surfaces  present  the  helix, —  the  fossa  of  the  helix, — 


EXTERNAL  AUDITORY  CANAL — TYMPANUM  OP  THE  EAR.  It 

the  anti-helix. —  the  fossa  of  the  anti-helix. —  the  concha, — 

the  tragus, — the  anti-tragus —  and  a  notch. 

The  Upper  Extremity  or  Base  is  rounded. 

The  Lower  Extremity  or  Apex  forms  the  lobule. 

215  Structure.  The  pavilion  is  composed : — 1st,  of  a  Cutaneous 
layer; — 2d,  of  a  Fibro-elastic  Cartilage  forming  the  bulk  of 
the  pavilion; — 3d,  of  Intrinsic  Muscles,  which  are  the  great 
muscle  of  the  helix,  the  small  muscle  of  the  helix,  the  mus- 
cle of  the  tragus,  the  muscle  of  the  anti-tragus,  the  trans- 
verse muscle; — 4th,  of  the  Extrinsic  Muscles,  which  are  the 
anterior  auricular,  the  superior  auricular  and  the  posterior 
auricular. 

EXTERNAL  AUDITORY  CANAL. 

216  Direction.  The  External  Auditory  Canal  is  directed  in- 
wards and  forwards; — it  also  curves  upwards  and  then 
downwards. 

Shape.     The  External  Auditory  canal,  at  its  beginning,  is 
oval; — in  the  middle  it  is  slightly  flattened. 
The  Anterior  Surface  is  in  relation  with  the  parotid  and 
lower  maxilla. 

The  Posterior  Surface  is  in  relation  with  the  mastoid  pro- 
cess. 

The  Upper  Border  is  convex  and  smooth. 
The  Lower  Border  is  concave  as  a  whole  but  presents  the 
projection  of  the  tragus. 

The  Outer  Extremity  is  continuous  with  the  pavilion. 
The  Inner  Extremity  is  in  relation  with  the  tympanum. 

217  Structure.  The  external  auditory  canal: — 1st,  is  lined 
throughout  with  Skin  presenting  the  Ceruminous  Glands: — 
2d,  the  Inner  Portion  is  osseous  and  formed  by  the  temporal 
bone; — 3d,  the  Outer  Portion  is  formed  of  a  cartilaginous 
gutter  below  and  of  a  membranous  portion  above,  like  the 
trachea. 

TYMPANUM  OR  DRUM  OF  THE  EAR. 

218  Shape.  The  Drum  of  the  Ear  is  irregularly  circular  or 
flattened. 

The  Outer  Wall  is  formed  by  the  Tympanic  Membram  . 
often  called  simply  the  tympanum; — it  is  connected  with 
the  mallet  and  anvil. 

The  Inner  Wall  presents  the  promontory. — the  apex  of 
the  osseous  canal  of  the  tensor  muscle  of  the  mallet. — the 
oval  window  corresponding  to  the  vestibule. —  the  round 
window  corresponding  to  the  cochlea. — the  pyramid  lodg- 
ing the  stapedius  muscle, —  and  the  ridge  of  the  Fallopian 
canal  situated  above  the  oval  window. 

The  Anterior  Wall  presents  the  orifice  of  the  Eustachian 
tube. 


78  OSSICLES  OF  THE  TYMPANUM — LINING  MEMBRANE. 

The  Posterior  Wall  presents  the  orifice  leading  into  the 
mastoid  cells. 

The  Upper  Wall  or  Roof  is  formed  by  a  thin  plate  of  bone 
separating  the  Tympanum  from  the  cranial  cavity. 
The  Lower  Wall  or  Floor  presents  the  glenoid  fissure  lodg- 
ing the  cord  of  the  Tympanum  and  the  Laxator  Muscle  of 
the  mallet. 

OSSICLES  OF  THE   TYMPANUM. 

219  Shape.  The  Ossicles  of  the  Tympanum  are  named,  after 
their  shape,  the  Mallet,  the  Anvil,  the  Lenticular  Bone  and 
the  Stirrup. 

They  form  an  irregular  chain  from  the  tympanic  mem- 
brane to  the  oval  window  which  is  closed  by  the  stirrup. 
Ligaments.  They  are  held  together  and  are  fastened  to 
the  surrounding  structures  by  various  ligaments. 
fluscles.  The  muscles  which  act  upon  them  are  the  Tensor 
Muscle  (of  the  mallet),  the  Muscle  of  the  Stirrup,  the  Large 
Laxator  Muscle  (of  the  mallet)  and  the  Small  Laxator  Muscle 
(of  the  mallet). 

LINING  MEMBRANE. 

220  The  tympanum  is  lined  by  a  mucous  membrane,  which  is 
the  prolongation  of  the  pharyngeal  mucous  membrane 
through  the  Eustachian  tube; — it  is  prolonged  into  the 
mastoid  cells. 

MASTOID  CELLS. 

221  The  mastoid  cells  are  irregular  cavities  in  the  substance  of 
the  mastoid  process  —  communicating  with  the  tympanum 
—  and  lined  by  a  mucous  membrane,  which  is  a  continua- 
tion of  the  membrane  of  the  tympanum. 

EUSTACHIAN  TUBE. 

222  Direction.  The  Eustachian  tube  is  directed  obliquely  in- 
wards, forwards  and  downwards. 

Shape.  The  Eustachian  tube  on  a  longitudinal  section  re- 
sembles two  cones  joined  at  their  apices  near  the  centre  of 
the  canal. 

The  Surfaces  are  in  relation  with  the  parotid  gland. 
The  Outer  Extremity  opens  on  the  lower  part  of  the  wall 
of  the  tympanum. 

The  Inner  Extremity  opens  by  an  expanded  orifice  on  the 
side  of  the  pharynx. 

223  Structure.  The  inner  three-fifths  are  composed  of  a 
grooved  cartilaginous  portion  below,  and  of  a  membranous 
portion  above.     The  outer  two-fifths  are  formed  of  osseous 


VESTIBULE — SEMI-CIRCULAR  CANALS — COCIILKA.  7!) 

tissue. —  Both  portions  are  lined  with  ;i  mucous  membrane, 
which  is  continuous  with  that  of  the  pharynx. 

224  Relative  Position  of  the  Parts  Composing  the  Internal 
Ear. 

The  Vestibule  is  between  the  tympanum  and  the  internal 
auditory  canal. — The  Semi-circular  Canals  are  situated  above 
the  vestibule. — The  Cochlea  is  situated  in  front  of  the  vesti- 
bule ;  its  base  corresponds  to  the  bottom  of  the  internal 
auditory  canal. 

VESTIBULE. 

225  Shape.     The  Vestibule  is  irregularly  oval. 

The  Surfaces  or  Walls  present  the  crest  of  the  vestibule, 

—  the  pyramidal  eminence  presenting  the  Inferior  Cribri- 
form Spot, —  the  hemi-elliptical  fossa, —  the  sulcif orm  fossa, 

—  the  orifices  of  the  semi-circular  canals,  one  of  which 
presents  the  vestibule, —  the  orifice  of  the  Superior  Cribri- 
form Spot, —  the  orifice  of  the  aqueduct  of  the  vestibular 
scala  of  the  cochlea, —  the  oval  window  corresponding  to  the 
stirrup  and  to  the  tympanum, —  the  round  window  or  orifice 
of  the  tympanic  scala  of  the  tympanum. 

226  Structure.  The  vestibule  is  composed: — 1st,  of  bony 
walls  distinct  from  the  petrous  bone; — 2d,  of  a  delicate 
periosteum  lining  of  the  walls; — 3d,  of  a  liquid  layer 
ealled  the  perilymph; — 4th,  of  a  membranous  layer  formed 
of  a  delicate  membrane  moulded  on  the  bony  walls  and  in 
which  the  vestibular  branches  of  the  auditory  nerve  termi- 
nate opposite  the  cribriform  spots  ;  at  that  point  are  found 
the  otoliths; —  5th,  of  a  liquid  contained  in  its  interior  and 
called  the  endolymph. 

SEMI-CIRCULAR  CANALS. 

227  Shape.  The  Semi-circular  canals  represent  each  more  than 
half  of  a  circle. 

The  Surfaces  or  Walls  are  in  relation  with  the  surrounding 

bony  tissue. 

The  Extremities  open  into  the  vestibule. 

228  Structure.  The  Semi-circular  canals  are  composed  : — 1st, 
of  bony  walls  distinct  from  the  petrous  bone; — 2d,  of  a 
delicate  periosteum  lining  these  walls; — 3d,  of  a  liquid 
layer  called  the  perilymph; — 4th,  of  a  membranous  layer 
formed  of  a  delicate  membrane  moulded  on  the  bony  walls  ; 

—  5th,  of  a  liquid  contained  in  its  interior  and  called  the 
endolymph. 

COCHLEA. 

229  Shape.     The  Cochlea  is  Conical  and  resembles  a  snail. 
The  Base  is  applied  to  the  bottom  of  the  auditory  canal. 
The  Apex  is  directed  forwards  and  outwards. 


80  INTERNAL  AUDITORY  CANAL — ORGANS  OF  HEARING. 

The  External  Surface  is  in  relation  with  the  osseous  tissue 
of  the  petrous  bone. 

The  Internal  Surface  encloses  a  cavity  divided  by  an  osteo- 
membranous  lamina  into  the  upper  or  tympanic  scala,  the 
middle  or  intra-membranous  scala  and  an  inferior  or  vestibular 
scala . 

230  Structure.  The  Tipper  and  Lower  Scala?  are  composed: — 
1st,  of  a  bony  wall; — 2d,  of  a  delicate  periosteum; — 3d, 
of  a  liquid  called  the  perilymph; — 4th,  of  a  layer  of  cells 
corresponding  to  the  outer  surface  of  the  membranous  por- 
tion of  the  spiral  lamina. 

The  Middle  Scala  is  formed : —  1st,  of  an  upper  and  lower 
membranous  wall; — 2d,  of  a  layer  of  lining  cells; — 3d,  of 
a  liquid  called  the  endolymph ; —  4th,  of  cells  called  the 
supporting  cells  ; —  5th,  of  peculiar  fibres  called  the  pillars 
or  fibres  of  Corti; — 6th,  of  peculiar  hair  cells  which  are 
the  termination  of  the  fibrils  of  the  auditory  nerve. 

INTERNAL  AUDITORY  CANAL. 

231  Direction.  The  Internal  Auditory  Canal  is  directed  ob- 
liquely downwards,  forwards  and  outwards. 

Shape.     It  is  cylindrical. 

The  External  Surface  is  in  relation  with  the  petrous  bone. 
The  Inner  Surface  is  lined  by  dura  mater. 
The  Internal  or  Cranial  Extremity  is  situated  on  the  pos- 
terior surface  of  the  petrous  bone. 

The  External  Extremity  or  Bottom  presents  above  the 
orifice  of  the  aqueduct  of  Fallopius  for  the  facial  nerve, 
and  below  the  orifice  for  the  vestibular  and  cochlear  nerves. 

232  Structure.  The  internal  auditory  canal  is  composed  : — 1st, 
of  an  osseous  layer  distinct  from  the  petrous  bone ; —  2d,  of 
a  fibrous  layer  formed  by  the  dura  mater; — 3d,  of  a  serous 
layer  formed  by  the  arachnoid. 

PECULIARITIES  OF  THE  ORGANS  OF  HEARING. 

233  Peculiarities  of  the  Pavilion. 

Is  unique  excepting  the  Fallopian  tube,  which  resembles  it. 

The  irregularities  of  the  surfaces  are  noticeable. 

Its  cutaneous  and  cartilaginous  structure  is  peculiar  (like 
the  nose). 

It  is  very  vascular ;  when  the  cord  of  the  tympanum  is 
cut  the  capillaries  become  engorged. 
Peculiarities  of  the  External  Auditory  Canal. 

Has  a  noticeable  course. 

The  presence  of  the  tympanic  membrane  at  its  internal 
extremity  is  unique. 

The  Ceruminous  Glands  are  peculiar  (like  the  Meibo- 
mians). 


PECULIARITIES  OF  THE  ORGANS  OF  HEARING.  81 

The  structure  of  the  canal,   half  fibro-cartilaginons   and 
half  osseous,  is  peculiar  (like  Eustachian  tube,  trachea). 
Peculiarities  of    the  Tympanum  or  Drum  of    the  Ear. 

It  is  unique. 

The  Tympanic  Membrane  is  unique. 

The  Round  and  Oval  windows  with  their  membranes  are 
unique. 

The  Chain  of  Ossicles,  with  their  ligaments  and  muscles. 
are  unique. 

The  thin  plate  of  the  upper  wall  is  noticeable. 

The  presence  of  the  Glenoid  fissure  and  the  cord  of  the 
tympanum  are  peculiar. 

The  Lining  membrane  coming  from  the  Pharynx  is  re- 
markable. 

It  presents  the  peculiar  nerve  of  Jacobson. 
Peculiarities  of  the  flastoid  Cells. 

They  are  noticeable. 

They  resemble  the  ethmoid,  cells. 
Peculiarities  of  the  Eustachian  Tube. 

It  is  unique. 

Its  direction  is  noticeable. 

Its  shape  also  (two  cones  joined  by  their  apices). 

The  opening  into  the  pharynx  is  unique. 

Its  structure,  half  fibro-cartilaginous  and.  half  osseous,  is 
noticeable  (like  the  external  auditory  canal). 
234  Peculiarities  of  the  Internal   Ear. 

Is  noticeable  in  all  particulars. 
Peculiarities  of  the  Vestibule. 

It  is  unique. 

The  cribriform  spots  are  noticeable. 

The  presence  of  the  perilymph,  of  the  membranous  vesti- 
bule, of  the  endolymph  are  peculiar  to  this  internal  ear. 

The  termination  of  the  fibrils  of  the  vestibular  nerve  and 
the  otoliths  is  unique. 

The  fact  that  the  bony  walls  of   the  vestibule,  canal  and 
cochlea  are  separate  from  the  petrous  bone  is  unique. 
Peculiarities  of  the  Semi=Circular  Canals. 

Are  unique  in  all  particulars. 

The  absence  of  nerve  terminations  is  noticeable. 
Peculiarities  of  the  Cochlea. 

It  is  unique. 

Its  shape  is  unique. 

The  base  being  applied  to  the  bottom    of  the  Internal 
Auditory  Canal  is  noticeable. 

The  division  of  the  interior  into  three  scales  is  peculiar. 

The  fibres  of  Corti  are  peculiar. 

The   course    and  termination   of   the    Cochlear   nerve    is 
peculiar. 
Peculiarities  of  the   Internal  Auditory  Canal. 

It  is  unique. 
G 


82  SKIN — HAIRS — GLANDS  OF  THE  SKIN. 

The  presence  at  the  bottom  of  two  large  divisions  is  no- 
ticeable. 

The  presence  in  its  interior  of  three  nerves  is  noticeable. 

The  Auditory  Nerve  is  a  soft  nerve. 

The  Petrous  bone  is  traversed  by  the  aqueduct  of  Fallo- 
pius  lodging  the  facial  nerve,  which  on  its  coarse  gives  off 
the  peculiar  cord  of  the  tympanum. 

.      SKIN. 

235  Layers.  The  Skin  is  composed  of  the  Epidermis  and  Der- 
mis. 

The  Epidermis  presents  the  following  layers : — 1st,  the 
Cuticle,  composed  of  flattened  cells ; — 2d,  the  Transparent 
Layer,  dimly  striated; — 3d,  the  Granular  Layer,  formed  of 
flattened  spindle-shaped  cells ;—  4th,  of  the  Mucous  Layer., 
composed  of  soft,  round  or  oval  cells; — 5th,  of  a  Layer  of 
Pigmented  Cells  in  the  negro; — 6th,  of  a  Basement  Mem- 
brane separating  the  deepest  cells  of  the  mucous  layer  from 
the  papilla?. 

The  Dermis  presents: — 1st,  the  Papillary  Layer,  formed 
of  vascular  and  nervous  papillas,  presenting  the  Tactile 
Corpuscles; — and  2d,  the  Dermis  Proper,  composed  of  con- 
nective tissue  and  a  few  smooth  muscular  fibres. 

HAIRS. 

236  Structure.     The  Hair  Follicle  is  a  depression  of  the  skin. 

It  is  composed: — 1st,  of  an  External  Layer,  corresponding 
to  the  dermis  proper ; —  2d,  of  an  Internal  Transparent  Layer, 
corresponding  to  the  basement  membrane  of  the  skin; — 3d, 
of  the  External  Root  Sheath,  corresponding  to  the  mucous 
layer; — 4th,  of  the  Internal  Root  Sheath,  corresponding  to 
the  cuticle  and  composed  of  a  layer  corresponding  to  the 
granular  layer  of  the  skin,  and  of  a  layer  corresponding  to 
the  transparent  layer  of  the  skin ; — 5th,  at  the  bottom  is  the 
Hair  Papilla  supporting  the  hair  bulb. 

The  Hair  Bulb  is  formed  of  an  agglomeration  of  soft, 
round,  oval  and  elongated  cells. 

The  Body  of  the  Hair  is  composed  of  : —  1st,  the  Cuticle ; 
—  2d,  of  the  Fibrous  or  Cortical  layer; — and  3d,  of  an  In- 
ternal or  Medullary  layer. 

GLANDS  OF  THE  SKIN. 

237  The  glands  of  the  skin  are  : — 1st,  the  Sebaceous  Glands,  situ- 
ated in  the  dermis  proper  and  almost  all  opening  into  the 
hair  follicles;  they  are  racemose  glands; — 2d,  the  Sweat 
Glands,  situated  in  the  meshes  of  the  deep  surface  of  the 
dermis  ;  they  are  convoluted  tubular  glands. 


NAILS — ORGANS  OF  LOCOMOTION.  83 


NAILS. 

238  Structure.  The  nails  arc  composed,  from  without  in- 
wards:— 1st,  of  a  Horny  Layer,  corresponding  to  the  epider- 
mis of  the  skin  ; — 2d,  of  a  Mucous  Layer; — 3d,  of  ;i  Papillary 
Layer  forming  the  matrix. 

239  Peculiarities  of  the  Skin. 

It  resembles  very  much  the  mucous  membranes. 

The  fact  that  the  superficial  layer  of  the  epidermis  or  the 
cuticle  is  composed  of  fiat,  dry,  dead  cells  is  noticeable. 

Also  that  the  deep  layer  or  mucous  layer  is  composed  of 
round  and  oval  soft  and  living'  cells. 

The  Pigmented  Cells  in  the  negro  are  peculiar. 

The  absence  of  all  vessels  and  nerves  in  the  above  layers 
is  noticeable. 

The  Papillae  are  peculiar  (like  in  the  tongue  only). 

The  termination  of  the  fibrils  of  the  nerves  into  the  tactile 
corpuscles  is  peculiar. 

Also  the  appearance  of  the  capillaries,  poplar-like,  as  in 
the  tongue. 
Peculiarities  of  the  Hair. 

They  are  peculiar  to  the  skin. 

The  hair  follicle  is  noticeable. 

Also  the  hair  papilla. 

The  structure  of  the  hair  bulb  is  peculiar. 

The  absence  of  all  vessels  and  nerves  is  noticeable. 

240  Peculiarities  of  the  Sebaceous  Glands. 

They  are  peculiar  to  the  skin. 

Their  opening  into  the  hair  follicles  is  peculiar. 

The  Ceruminous  Glands  are  varieties  of  sebaceous  glands. 

The  Meibomian  Glands  also. 
Peculiarities  of  the  Nails. 

They  are  unique. 

The  fact  that  they  correspond  to  the  cuticle  in  other  situ- 
ations is  noticeable. 

Absence  of  intermediate  capillaries  is  remarkable. 


ORGANS  OF  LOCOMOTION. 

CARTILAGES. 


241  Structure.     Cartilages  are  composed  : 

1st.  Of  an  investing  membrane  called  the  Perichondrium. 

2d.  Of  a  Matrix  or  Interstitial  Substana  which  is  amor- 
phous, homogeneous  or  granular. 

3d.  Of  Cartilage  Lacuna  lined  by  a  capsule  containing 
fluid  and  one  or  more  nucleated  cells. 


84       BONES — RESUME  OF  POINTS  CONCERNING  THE  VERTEBRAE. 

242  Varieties.  There  are  the  following  varieties  of  cartilage : 
the  true  cartilage  (deprived  of  matrix),  the  fibro -cartilage , 
and  the  fibro-elastic  cartilage. 

BONES. 

243  Chemical  Composition  of  Bones.  The  Earthy  Elements 
are  phosphates  and  carbonates  of  lime,  which  form  the  two- 
thirds. 

They  are  demonstrated  by  macerating  a  bone  in  a  diluted 
acid. 

The  Organic  Elements  form  one-third. 
They  are  demonstrated  by  burning  a  bone. 

244  Structure  of  Bones.     Bones  are  composed : 

1st.  Of  an  envelope,  the  Periosteum,  the  outer  layer  of 
which  is  fibrous,  but  the  inner  is  formed  of  cells  and  capil- 
laries. 

2d.  Of  a  Proper  Tissue  composed  of  the  Haversian  Canals, 
which  contain  the  blood  vessels. 

3d.  Of  the  Lacuna?  and  Canalicules  which  convey  the 
serum  of  the  blood  throughout  the  substance  of  the  bone. 

4th.  Of  the  Medulla  or  Marrow,  which  is  either  yellow  or 
red. 

It  is  composed  of  alveoles  containing  fat  cells,  and  in  the 
red  marrow  peculiar  cells  called  medulla-cells  and  the  multi- 
nucleated cells  or  giant-cells. 


RESUHE  OF  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  VERTEBRAE. 

1.  CERVICAL  VERTEBRAE. 

245  The  body  presents  two  tubercles; — the  transverse  processes 
are  grooved  and  present  orifices  for  vertebral  arteries ; — the 
spinal  orifice  is  large  and  triangular; — the  spinal  process  is 
bifid. 

246  First  Cervical  or  Atlas  :  The  body  is  narrow ;  it  is  re- 
placed by  two  arches ;  the  spinal  orifice  is  very  large ;  the 
front  is  filled  by  the  odontoid  process ;  the  articular  sur- 
faces are  very  large; — the  spinous  process  is  nearly  absent. 

Second  Cervical  or  Axis :  is  characterized  by  the  odon- 
toid process. 

Seventh  Cervical  :  is  characterized  by  a  prominent 
spinous  process. 

2.     DORSAL  VERTEBRA. 

247  The  body  presents  articular  facets; — the  spinal  orifice  is 
small  and  round  ; — the  spinous  process  is  large  and  oblique  ; 


LUMBAR  VERTEBRAE — SACRUM — SPINE  IX  GENERAL.  85 

— the  transverse  processes  present  articular  facets  for  tin- 
ribs. 

248  First  Dorsal.     The  body  presents  a  full  facet. 
Ninth   Dorsal.     The  body  presents  ;i  demi-facet  above. 
Tenth  Dorsal.     The  body  presents  only  one  facet  which  is 
entire. 

Eleventh  Dorsal.  The  body  presents  only  one  facet  which 
is  entire; — the  transverse  processes  present  no  articular 
facets  for  ribs. 

Twelfth  Dorsal.  Same;  the  inferior  articular  surfaces  are 
convex  and  turned  outwards. 

3.     LUMBAR  VERTEBRA. 

249  Lumbar  Vertebrae.      The  body  presents  no  tubercle,    no 

facet; — the  spinal  orifice  is  small  and  triangular; — the 
spinous  process  is  short  and  thick; — the  transverse  processes 
are  long  and  present  processes  resembling  rudimentary 
ribs; — the  upper  articular  process  presents  a  marked  tuber- 
cle. 

Fifth  Lumbar.  The  inferior  articular  facets  are  wider 
apart; — the  transverse  processes  are  larger  and  thicker. 

SACRUM. 

250  The  Anterior  Surface  presents, —  on  the  middle  line,  trans- 
verse ridges  ; — and  on  the  sides  the  anterior  sacral  foramina. 
The  Posterior  Surface  presents, — on  the  middle  line,  the 
spinous  processes; — and  on  the  sides,  the  sacral  grooves. 
posterior  sacral  orifices  and  transverse  processes. 

The  Base  presents, —  on  the  middle  line,  the  articular  sur- 
face for  the  fifth  lumbar,  the  orifice  of  the  sacral  canal  — 
and  on  the  sides,  the  round  edge  of  the  brim,  and  a  fiat  sur- 
face above. 

The  Lateral  Surfaces  present — above,  the  articular  surface, 
which  is  lined  in  front  with  cartilage,  but  behind  is  rough  ; 
—  beloiv,  the  surface  presents  a  border  giving  attachment  to 
the  sacro-sciatic  ligaments. 

The  Apex  presents  the  orifice  of  the  sacral  canal,  and  the 
articular  surface  for  the  coccyx. 

SPINE  IN  GENERAL. 

251  Direction.  The  Spine  presents  a  convexity  in  the  cervical 
region,  a  concavity  in  the  dorsal  region,  a  second  convexity 
in  the  lumbar  region  and  a  second  concavity  in  the  sacral. — 
Besides,  it  presents  a  left  lateral  concavity  opposite  the 
upper  dorsal  vertebra?  for  the  lodgment  of  the  aorta. 
Shape.  The  spine  has  the  shape  of  two  pyramids  opposed 
by  their  bases,  the  sacral  and  the  vertebral. 

Besides,  the  cervical  vertebra-  represent  a  pyramid  whose 


86  BONES  OF  THE  SKULL — FRONTAL. 

apex  joins  the  apex  of  the  pyramid  formed  by  the  dorsal 
vertebrae. 

The  Anterior  Surface  presents  the  bodies  of  the  vertebra?. 
The  Lateral  Surfaces  present  the  intervertebral  foramina, 
tbe  pedicles,  the  transverse  processes,  the  articular  pro- 
cesses. 

The  Posterior  Surface  presents  the  spinous  processes  and 
the  laminae. 

The  Upper  Extremity  articulates  with  the  occipital. 
The  Inferior  Extremity  is  formed  by  the  coccyx; — it  gives 
attachment  to  the  anal  sphincter. 

The  Spinal  Canal  is  large  and  oval  in  the  cervical  region ; 
—  it  is  smaller  and  round  in  the  dorsal  region  ;  — it  enlarges 
again  in  the  lumbar,  where  it  is  also  oval. 

BONES  OF  THE  SKULL. 

252  Enumeration.  The  Bones  of  the  Cranium  are: — on  the 
Median  line  and  Single,  the  Frontal,  Ethmoid,  Sphenoid, 
Occipital; — on  the  Sides  and  Double,  the  Parietal  and  Tem- 
poral. 

FRONTAL. 

253  1st.  The  Vertical  Portion  or  Frontal  Proper. 

The  Anterior  Surface  presents  on  the  median  line:  the 
ridge  or  suture  between  the  two  halves  of  the  bone, —  the 
nasal  eminence  articulating  with  nasal  bones, — the  nasal 
notch  and  the  nasal  spine  or  process. 

It  presents  on  the  sides  the  frontal  eminence  or  protuber- 
ance,—  the  superciliary  eminence  or  ridge  corresponding  to 
the  frontal  sinus, — the  supra-orbital  notch  or  foramen, — 
the  internal  angular  or  orbital  process, —  the  external  angu- 
lar or  orbital  process. 

The  Posterior  Surface  presents  on  the  median  line  the 
groove  of  origin  of  the  superior  longitudinal  sinus, — the 
frontal  crest  giving  attachment  to  cerebral  falx, — the  caecal 
foramen. 

It  presents,  on  the  sides,  the  frontal  fossa,  presenting  emi- 
nences and  depressions  corresponding  to  the  convolutions, 
and  the  Pacchionian  depressions. 

254  2d.   Horizontal  Portion  or  Orbital  Vaults. 

The  Inferior  Surface  presents  on  the  median  line  the  eth- 
moidal notch  articulating  with  ethmoid, — the  nasal  spine, — 
the  openings  of  the  frontal  sinus. 

It  presents  on  the  sides  the  orbital  fossa  or  concavity  of 
the  vault, — the  lachrymal  fossa. 

The  Upper  Surface  presents  on  the  median  line  the  eth- 
moidal notch, —  and  on  the  sides  the  orbital  vault  or  convex- 
ity of  the  vault,  presenting  eminences  and  depressions  cor- 
responding to  the  convolutions. 


ETHMOID.  ^7 

'17)7)  3d.   Lateral  Portions. 

The  External  Surface  forms  part  of  the  temporal  fossa  ;  — 
it  is  separated  by  the  temporal  ridge  from  the  temporal  por- 
tion of  the  bone. 

The  Internal  Surface  forms  part  of  the  anterior  cerebral 
fossa. 

The  Upper  Border  of  the  Frontal  is  serrated,  beveled  and 
articulates  with  the  parietal  hones; — it  forms  the  fronto- 
parietal suture. 

The  Inferior  Border  is  not  serrated, —  it  articulates  with 
the  sphenoid. 

The  Upper  Angle  of  the  Frontal  articulates  with  the  re- 
ceding' angle  of  the  two  parietal; — it  forms  the  anterior 
fontanelle. 

The  Outer  Angle  (external  angular  or  orbital  process)  ar- 
ticulates with  the  malar  bone. 

ETHMOID. 

256  Situation.  The  Ethmoid  is  situated  in  the  ethmoidal  notch 
of  the  frontal  bone  in  front  of  the  sphenoid,  protruding 
into  and  forming  all  the  upper  part  of  the  nasal  cavities. 

257  1.  The  Horizontal  or  Cribriform  Plate  presents  on  the 
median  line  the  caeeal  foramen,  the  crista-galli,  an  eminence 
for  the  attachment  of  the  cerebral  falx. 

It  presents  on  the  s'uhs  the  olfactory  groove  for  the  olfactory 
nerve, — the  foramina  for  the  filaments  of  the  olfactory  nerve, 
—  the  posterior  notch  articulating  with  the  sphenoid. 

258  2.  The  Perpendicular  Plate  presents  surfaces  and  bor- 
ders. 

The  Surfaces  form  the  upper  part  of  the  nasal  septum. 

The  Upper  Border  is  attached  to  the  horizontal  plate. 

The  Lower  Border  articulates  with  the  triangular  cartilage 

of  the  septum. 

The  Anterior  Border  articulates  with  the   nasal   spine  (of 

the  frontal). 

The  Posterior  Border   articulates  with  the   rostrum   of  the 

sphenoid  and  the  vomer. 

259  3.  The  Lateral  Masses  or  the  Ethmoid  Cells  present  also 
surfaces  and  borders. 

The  Upper  Surface  articulates  with  the  ethmoidal   notch 

of  frontal. 

The  Anterior  Surface  articulates  with  the  Lachrymal  bone 

and  nasal  process  of  superior  maxilla. 

The  Inferior  Surface  articulates  with  the  superior  maxilla 

itself. 

The  Posterior  Surface  articulates  with  the  sphenoid  and 

palate  bones. 

The  External    Surface    is    called    the  Os   Planum; — it  is 

smooth,  thin, —  forms  part  of  the  orbit, —  articulates  above 


88  SPHENOID — BODY  OF  SPHENOID — LESSER  WINGS. 

with  the  frontal,  in  part  with  the  lachrymal,  below  with  the 
superior  maxilla  and  palate  bones,  behind  with  the  sphe- 
noid. 

The  Internal  Surface  forms  the  upper  part  of  the  exter- 
nal wall  of  the  nasal  cavities ; —  it  presents  two  processes, 
called  the  superior  and  middle  turbinated  processes,  and  in 
front  a  surface  for  the  filaments  of  the  olfactory  nerves. 

260  4.  The  Ethmoid  Cells  form  two  groups  not  communicating 
with  each  other,  the  anterior  or  frontal  and  the  posterior  or 
sphenoidal. 

SPHENOID. 

261  Situation.  The  sphenoid  is  situated  at  the  base  of  the 
skull,  between  the  occipital  and  the  frontal. 

It  articulates  with  the  other  cranial  bones. 
It  presents  a  Body,  Two  Large  Wings,  Two  Small  Wings, 
and  Two  Pterygoid  Processes. 

BODY  OF  SPHENOID. 

262  The  Upper  Surface  presents  on  the  Median  line:  smooth 
surfaces  giving  passage  to  the  olfactory  nerve  ; —  the  optic 
grooves  for  the  optic  nerves; — the  pituitary  fossa; — the 
square  surface  for  oblong  medulla. 

It  presents  on  the  sides  the  optic  foramen, —  the  anterior 
clinbid  processes, —  the  orifice  or  notch  communicating  with 
the  cavernous  sinus, —  the  posterior  clinoid  processes. 
The  Anterior  Surface  presents  on  the  median  line,  the  ante- 
rior sphenoidal  spine; — it  articulates  with  the  ethmoid. 

It  presents  on  the  sides  the  orifice  leading  into  the  sphe- 
noidal sinus, — the  sphenoidal  turbinated  bones,  which  are 
two  thin  curved  plates  of  bone  partially  closing  the  orifice 
of  the  sphenoidal  sinus. 

The  Inferior  Surface  presents  on  the  median  line,  the  ros- 
trum or  sphenoidal  spine  articulating  with  the  vomer. 

It  presents  on  the  sides  the  vaginal  process  wnich  forms  a 
groove  articulating  with  the  wing  of  the  vomer ; — the  ptery- 
gopalatine groove  articulates  with  the  palate  bone  and 
forms  the  ptery go-palatine  canal. 

The  Posterior  Surface  articulates  with  the  occipital ;  —  it 
is  often  united  with  it. 

The  Lateral  Surfaces  present  above  the  cavernous  groove; 
—  below  they  are  blended  with  the  great  wing. 

THE  LESSER  WINGS  OR  UPPER  WINGS. 

263  The  Upper  Surface  is  smooth  and  is  in  relation  with  the 
anterior  lobe  of  the  brain. 

The  Under  Surface  forms  part  of  the  roof  of  the  orbit. 
The  Anterior  Border  articulates  with  frontal. 


GREATER  WINGS — PTERYGOID  PROCESSES  OR  LOWER  W1XOS.  89 

The    Posterior    Border    is    smooth,  free, —  and   tonus    the 

upper  boundary  of  the  sphenoidal  fissure. 

The  Base  presents  the  anterior  clinoid  processes  and  the 

optie  foramen. 

The  Apex  terminates  in  a  sharp  point. 


GREATER  WINGS  OR  MIDDLE  WINGS. 

2(54  The  Upper  Surface  presents  the  round  foramen, —  the  oval 
foramen, —  the  Vesalian  foramen, —  the  spinous  foramen, — 
the  spinous  process, —  and  the  fossa  forming  part  of  the 
middle  cerebral  fossa. 

The  Inferior  Surface  presents  a  surface  forming  the  roof 
of  the  zygomatic  fossa, — the  oval  foramen  —  and  the 
spinous  foramen. 

The  External  Surface  presents  the  pterygoid  ridge  which 
separates  this  surface  from  the  inferior  surface, —  the  sur- 
face forming  part  of  the  temporal  fossa. 
The  Internal  or  Anterior  Surface  forms  part  of  the  outer 
wall  of  the  orbit ; —  behind,  it  forms  part  of  the  sphenoidal 
fissure  ; —  below,  it  forms  part  of  the   sphenopalatine  ori- 
fice and  of  the  ptery go-maxillary  fissure. 
The  Anterior  Border  articulates  with  the  malar  bone. 
The  Superior  Border  articulates  with  the  frontal  bone  and 
parietal  bone. 

The  External  Border  articulates  with  the  squamous  tem- 
poral bone. 

The  Posterior  Border  articulates  with  the  petrous  temporal 
bone. 
The  Internal  Border  is  blended  with  the  body. 


PTERYGOID  PROCESSES  OR  LOWER  WINGS. 

265  The  Anterior  Surface  above  forms  the  posterior  boundary 
of  the  spheno-maxillary  fossa, —  and  presents  a  groove  form- 
ing the  ptery  go -maxillary  canal ; —  be  low  it  articulates  with 
the  palate  bone. 

The  Posterior  Surface  presents  the  scaphoid  fossa  —  and 
the  pterygoid  fossa,  which  is  limited  by  the  inner  and  outer 
pterygoid  plates. 

The  External  Surface  forms  part  of  the  zygomatic  fossa. 
The  Internal  Surface  forms  the  outer  boundary  of  the 
posterior  nares. 

The  Base  is  attached  to  the  body  of  the  greater  wing: —  it 
presents  the  Vidian  canal — and  the  round  foramen. 
The  Apex  is  notched; — it  presents  the  hamular process  con- 
nected with  the  inner  plate, — it  articulates  with  the  palate. 


90  OCCIPITAL — PARIETAL  BONES. 


OCCIPITAL. 

266  Situation.  The  Occipital  is  situated  at  the  posterior  part 
of  the  skull. 

The  External  Surface  presents  on  the  median  line  a  smooth 
surface  for  the  occipital-frontal  muscle, — the  external  occip- 
ital protuberance, —  the  occipital  crest, —  the  occipital  for- 
amen with  the  tubercles  for  the  check  ligaments, —  the  bas- 
ilar process. 

It  presents  on  the  sides  —  the  superior  curved  line, — 
the  inferior  curved  line, —  the  posterior  condyloid  fossa  and 
foramen, —  the  jugular  process, —  the  occipital  condyle, — 
and  the  anterior  condoloid  fossa  and  foramen. 
The  Internal  Surface  presents  on  the  median  line  a  groove 
for  the  superior  longitudinal  sinus, — 'the  internal  occipital 
protuberance  with  the  press  of  Herophilus, —  the  internal 
occipital  crest  with  grooves  for  the  occipital  sinus,  —  the  oc- 
cipital foramen,—  with  anterior  condyloid  foramen, — the 
basilar  groove,  for  oblong  medulla. 

It  presents  on  the  sides  : — the  cerebral  fossa, —  the 
groove  of  the  lateral  sinus, —  the  cerebellar  fossa, —  the 
jugular  process, —  the  depression  for  the  terminal  groove  of 
lateral  sinus, — and  the  anterior  condyloid  foramen. 
The  Upper  Border  is  serrated; — it  articulates  with  the  pari- 
etal bones  and  forms  the  lambdoid  suture. 
The  Inferior  Border  between  the  external  angle  and  jugular 
process  articulates  with  the  mastoid  temporal  bone ; —  be- 
tween the  jugular  process  and  the  anterior  angle  it  articulates 
with  the  petrous  bone — and  forms  the  jugular  foramen  or 
posterior  lacerated  foramen. 

The  Upper  Angle  articulates  with  the  parietal  bones —  and 
forms  the  posterior  fontanelle. 

The  External  Angle  articulates  with  parietal  bones  —  and 
the  mastoid  process. 
The  Anterior  Angle  articulates  with  the  body  of  sphenoid. 

PARIETAL  BONES. 

267  The  External  Surface  presents  the  parietal  foramen, —  a 
smooth  surface  for  the  occipito-frontal  muscle, — the  tempo- 
ral ridge, —  the  parietal  eminence  or  protuberance — and 
the  surface  of  temporal  fossa. 

The  Internal  Surface  presents  a  groove  for  the  superior 
longitudinal  sinus, —  the  Pacchionian  depressions, —  the 
parietal  fossa, —  the  grooves  for  middle  meningeal  artery, 
the  main  branch  starting  from  the  anterior  inferior  angle  ; — 
the  groove  for  the  terminal  portion  of  lateral  sinus. 
The  Anterior  Border  is  serrated; — it  articulates  with  the 
frontal,  forming  the  coronal  suture. 


TEMPORAL  BONES.  !)1 

The  Upper  Border  is  serrated; — it  articulates  with  its  fel- 
low—  and  forms  the  bi-parietal  or  sagittal  suture. 
The  Posterior    Border    is    serrated — and  articulates    with 
the  occipital,  forming  the  lambdoid  suture. 
The  Inferior  Border  is  beveled; — it    articulates    with   the 
squamous  temporal  bone. 

The  Inferior  Anterior  Angle  articulates   with  the  frontal 
and  sphenoid. 

The  Superior  Anterior  Angle  articulates  with  the  frontal  — 
and  forms  the  anterior  fontanelle. 

Superior  Posterior  Angle  articulates  with  the  occipital, — 
and  forms  the  posterior  fontanelle. 

The  Inferior  Posterior  Angle  articulates  with  the   mastoid 
temporal  bone. 

TEMPORAL  BONES— SQUAMOUS  PORTION. 

268  The  External  Surface  presents  a  surface  forming-  the  tem- 
poral fossa, —  the  posterior  limit  of  the  temporal  ridge,  — 
the  Zt/f/onuitic  Process. 

The  external  surface  of  this   process  is  subcutaneous  ; — 
it  forms  the  external  boundary  of  the  temporal  fossa. 

The  upper  border  gives  attachment  to  the  temporal  fascia. 

The  lower  border  gives  attachment  to  the  masseter. 

The  apex  articulates  with  the  malar  bone. 

The  base  presents  the  exterior  transverse  root  of  the  zy- 
goma —  the  zygomatic  tubercle  for  the  attachment  of  the 
external  lateral  ligaments; — the  articular  eminence,—  the 
glenoid  fossa, —  the  posterior  root,  which  is  continuous  with 
the  posterior  limit  of  the  temporal  riclge. 
The  Internal  Surface  presents  eminences  and  depressions 
for  the  convolutions  of  the  brain, —  and  grooves  for  the 
middle  meningeal  artery. 

The  Upper  Border  articulates  with  the  parietal  bone  —  and 
forms  the  squamous  suture. 

The  Anterior  Border  articulates  with  the  greater  wing  of 
the  sphenoid. 
The  Inferior  Border  is  blended  with  the  petrous  boue. 

MASTOID  PORTION. 

269  The  External  Surface  is  rough  —  and  presentsthe  mastoid 
foramen. 

The  Internal  Surface  presents  the  terminal  groove  of  the 

lateral  sinus. 

The  Posterior  Border  articulates  with  the  occipital. 

TI13  Anterior   Border  is  blended  with  the   squamous  and 

petrous  bones. 

The  Base  articulates  with  the  parietal. 

The   Apex    presents    the    mastoid    process. —  the    digastric 

groove  —  and  the  groove  for  the  occipital  artery. 


92  PETROUS  PORTION — BONES  OF  THE  FACE — VOMER. 


PETROUS  PORTION. 

270  The  Anterior  Surface  presents  from  within  outwards : 
the  fossa  for  the  Gasserian  ganglion, — the  groove  for  the 
small  petrosal  nerve, — the  hiatus  of  Fallopius  for  the  large 
petrosal  nerve, — the  projection  of  the  superior  semi-cireular 
canal, — and  the  thin  roof  of  the  tympanum. 

The  Posterior  Surface  presents  from  within  outwards  — 
the  internal  auditory  meatus, — the  aqueduct  of  the  vesti- 
bule. 

The  Inferior  Surface  presents  a  rough  surface  for  muscu- 
lar attachments, — the  orifice  of  carotid  canal, — the  jugular 
fossa, — the  jugular  surface, — the  stylo-mastoid  foramen, — 
the  styloid  process, —  the  vaginal  process, — the  posterior 
glenoid  fossa, — and  the  auditory  process. 
The  Anterior  Border  presents  a  free  portion  which  articu- 
lates with  the  spinous  process  of  the  sphenoid  ; — in  the  re- 
ceding angle  we  find  the  orifices  of  the  Eustachian  tube  and 
of  the  canal  for  the  tensor  muscle  of  the  mallet; — it  is 
partly  blended  with  the  squamous  portion. 
The  Upper  Border  presents  the  superior  petrosal  sinus. 
The  Posterior   Border  presents  a  groove  for  the  inferior 
petrosal  sinus, —  the  notch  for  the  jugular  foramen. 
The  Base  is  blended  with  the  squamous  and  mastoid  bones  ; 
—  it  presents  the  external  auditory  meatus. 
The  Apex  articulates  with  the  sphenoid  and  the  occipital ; — 
it  presents  the  internal  orifice  of  the  carotidian  canal. 

BONES  OF  THE  FACE. 

271  The  Upper  Jaw  comprises  thirteen  bones,  which  are :  on 
the  Middle  Line,  the  Vomer; — on  the  Sides,  the  Nasal, 
Lachrymal,  Inferior  Turbinated,  Palate,  Superior  Maxillar 
and  Malar  Bones. 

The  Lower  Jaw  contains  only  the  Inferior  Maxillary  Bone. 

VOMER. 

272  Situation.  The  Vomer  is  situated  at  the  back  part  of  the 
nasal  septum. 

The  Surfaces  are  alternately  concave  and  convex. 

The  Upper  Border  presents  a  groove  articulating  with  the 

rostrum  of  the  sphenoid ; — it  presents  also  laminas  or  wings 

articulating  with  the  vaginal  process  of  the  sphenoid. 

The  Lower  Border  articulates  with  the  palate  processes  of 

the  superior  maxillary  bone. 

The  Posterior   Border  is  free  and  concave ; — it  separates 

the  posterior  nares. 

The  Anterior  Border  articulates  with  the  ethmoid, —  and 

also  with  the  septal  cartilage  of  the  nose. 


SUPERIOR  MAXILLARY  BONE — NASAL  BONE.  93 


SUPERIOR  MAXILLARY  BONE. 

273  The  Internal  Surface  presents  the  nasal  process,  the  inter- 
nal surface  of  which  presents  two  ridges  for  articulation, 

with  the  middle  and  inferior  turbinated  bones,  and  between 
them  the  middle  meatus; — the  lachrymal  groove  and  sac, — 
the  nasal  canal, —  the  inferior  meatus, — the  opening  of  the 
antrum  of  Highmore, —  an  articular  surface, — the  maxillary 
fissure  for  the  process  of  the  palate  bone. 

The  Palate  Process  presents  an  Upper  Surface  forming  part 
of  the  floor  of  the  nasal  cavity, — an  Under  Surface  forming  the 
roof  of  the  mouth  and  hard  palate  ; — an  Outer  Border  blended 
with  the  bone, —  an  Inner  Border  articulating  with  its  fel- 
low,—  a  Base  traversed  by  the  anterior  palatine  (incisive) 
canal, —  an  Apex  or  Posterior  Border  articulating  with  the 
palate  bone. 

The  External  Surface  presents  the  nasal  process  (external 
surface) — the  anterior  margin  of  the  orbit, — the  infra-or- 
bital foramen, — the  canine  fossa, —  the  incisive  or  myrti- 
form  fossa, — the  ridge  of  the  alveole  of  the  canine  tooth. 
The  Upper  Surface  forms  the  floor  of  the  orbit. 

It  presents  the  infra-orbital  groove, — a  depression  for  the 
insertion  of  the  inferior  oblique  muscle, — the  malar  pro- 
cess articulating  with  the  malar  bone. 

The  Posterior  Surface  presents  the  posterior  margin  of 
the  orbit  or  anterior  boundary  of  spheno-maxillary  fissure, 
—  the  orifices  of  the  posterior  dental  canals, —  a  concave 
surface  corresponding  to  the  malar  process  and  to  the  zygo- 
matic fossa. 
The  Anterior  Border  articulates  with  the  nasal  bone. 

It  presents  a  notch  giving  attachment  to  the  lateral  carti- 
lage of  the  nose, —  the  anterior  spinous  process  of  superior 
maxilla. 

The  Superior  Border  presents  the  apex  of  the  nasal  process 
articulating  with  frontal  bone, —  the  lachrymal  groove, 
where  it  articulates  with  the  lachrymal  bone  ; — further  back 
it  articulates  with  the  ethmoid  and  palate  bones. 
The  Inferior  Border  is  called  the  alveolar  process; — it  pre- 
sents the  sockets  for  the  teeth. 

The  Posterior  Border  is  called  the  tuberosity  of  tin  supi  ri>>r 
maxilla; — it  forms  the  pterygo-maxillary  fissure. —  articu- 
lates with  the  palate  bone, —  and  forms  the  posterior  pala- 
tine canal 

NASAL  BONES. 

274  Situation.     The  Nasal  Bones  form  the  upper  part  of  bridge 
of  the  nose. 

The  Outer  Surface  gives  attachment  to  muscles. 

The  Inner  Surface  forms  part  of  the  nasal  cavities. —  ami 

presents  a  groove  for  a  branch  of  the  nasal  nerve. 


94  LACHRYMAL  BONES — INFERIOR  TURBINATED  BONES. 

The  Anterior  Border  articulates  with  its  fellow; — it  pre- 
sents a  groove  articulating  with  the  nasal  spine  of  the  fron- 
tal and  with  the  ethmoid. 

The  Posterior  Border  articulates  with  the  nasal  process  of 
the  superior  maxilla. 

The  Apex  articulates  with  the  frontal  bone. 
The  Base  articulates  with  the  lateral  nasal  cartilage  —  and 
presents  a  notch  for  the  nasal  nerve. 

LACHRYMAL  BONES. 

275  Situation.  The  Lachrymal  Bones  are  situated  on  the  front 
part  of  the  inner  wall  of  the  orbit. 

The  External  Surface  presents  a  groove  for  the  lachrymal 
canal, —  a  ridge  for  the  attachment  of  the  tensor  muscle  of 
the  tarsal  cartilages, —  and  a  surface  forming  part  of  the 
orbit. 

The  Internal  Surface  forms  a  part  of  the  nasal  cavity. 
The  Anterior  Border  articulates  with  the  nasal  process  of 
the  superior  maxilla. 

The  Posterior  Border  articulates  with  the  ethmoid. 
The  Apex  articulates  with  the  internal  angular  process  of 
the  frontal. 

The  Base  presents  the  lachrymal  process  articulating  with 
the  inferior  turbinated  bone, —  the  lower  edge  of  the  verti- 
cal crest ;— -  it  articulates  with  superior  maxilla. 

INFERIOR  TURBINATED   BONES. 

276  Situation.  The  Inferior  Turbinated  Bones  are  situated  on 
the  outer  wall  of  the  nasal  fossa,  immediately  below  the  ori- 
fice of  the  antrum. 

The    Internal    Surface   is   convex, —  is   ragged   and   per- 
forated;— it  forms  the  inferior  meatus. 
The  Upper  Border  articulates  with  the  superior  maxilla. — 
Behind,  it  articulates  with  the  palate  bone. 
The  Lower  Border  is  free  and  rounded. 
The  Anterior  Extremity  is  pointed. 
The  Posterior  Extremity  is  also  pointed. 

PALATE   BONES. 

Situation.  The  Palate  Bones  are  situated  back  of  the 
nasal  fossas,  resting  on  the  posterior  border  of  the  superior 
maxilla. 

They  present  an  horizontal  and  a  vertical  plate. 

HORIZONTAL  PLATE. 

277  The  Upper  Surface  forms  the  back  part  of  the  floor  of  the 
nasal  cavities. 


VERTICAL  PLATE — MALAR  BONES.  '.»."> 

The  Under  Surface  forms  the  back  part  of  the  root'  of  the 

mouth  or  hard  palate. 

The  Anterior  Border  articulates  with  the  palate  process  of 

the  superior  maxilla. 

The  Internal    Border   articulates   with    its  fellow  and  the 

vomer. 

The  Posterior  Border  is  free  —  and  gives  attachment  to  the 

soft  palate. 

The  External  Border  is  blended  with  the  vertical  plate. 

VERTICAL  PLATE. 

278  The  Internal  Surface  presents  the  superior  meatus  —  the 
middle  turbinated  crest, — the  middle  meatus, —  the  inferior 
turbinated  crest, —  the  inferior  meatus. 

The  External  Surface  forms  a  part  of  the  pterygo-maxil- 
lary  fossa ; — it  articulates  with  the  superior  maxilla. 
The  Anterior  Border  forms  part  of  the  edge  of  the   an- 
trum. 

The  Inferior  Border  is  blended  with  the  horizontal  plate. 
The  Posterior  Border  presents  a  groove  articulating  with 
the  pterygoid  process  of  the  sphenoid  ; — the  pterygoid  pro- 
cess or  tuberosity  of  the  palate  articulating  with  the  notch 
of  the  apex  of  the  pterygoid  process  of  the  sphenoid. 
The  Upper  Border  presents  —  the  Orbital  Process,  present- 
ing three  articular  surfaces :  the  anterior  or  maxillary,  the 
internal  or  ethmoidal,  the  posterior  or  sphenoidal  and  two 
facets  for  connection,  an  upper  or  orbital  and  an  external  or 
zygomatic. 

It  presents  also  the  Spheno-palatine  Notch  and  the  Sphe- 
noidal Process. 

The  upper  surface  of  the  sphenoidal  process  articulates 
with  the  sphenoidal  turbinated  bone; — the  inner  surface  of 
the  nasal  forms  part  of  the  wall  of  the  nasal  cavity; — the 
outer  surface  forms  part  of  the  spheno-maxillary  fossa  and 
articulates  with  the  pterygoid  process  of  sphenoid  ; — the  an- 
terior border  forms  part  of  spheno-palatine  foramen  —  and 
the  posterior  border  articulates  with  the  pterygoid  process. 

MALAR  BONES. 

279  Situation.  The  Malar  Bones  form  the  prominence  of  the 
cheeks. 

The  External  Surface  presents  the  malar  foramina. 

The  Internal  Surface  forms  the  outer  wall  of  the  temporal 

fossa. 

The  Anterior  Surface  forms  part  of  the  orbit. 

The  Superior    Border    forms  part  of   the   margin   of  the 

orbit. 

The  Anterior  Border  articulates  with  the  malar  process  of 

the  superior  maxilla. 


96    INFERIOR  MAXILLARY  BONE — HORIZONTAL  PORTION  OR  BODY. 

The  Inferior  Border  forms  part  of  the  zygomatic  arch. 

The  Posterior  Border  is  smooth  above  —  and  limits  the 

temporal  fossa; — it  articulates  below  with  the  zygomatic 

process. 

The  Internal  Border  articulates  with  the  frontal  above  and 

the  sphenoid  below. 

INFERIOR  MAXILLARY  BONE. 

Situation.     The  Inferior  Maxillary  forms  the  lower  jaw. 

HORIZONTAL  PORTION  OR  BODY. 

280  The    External    Surface    presents  on   the   middle   line  the 
symphysis  —  and  the  mental  process. 

It  presents  on  the  sides  the  incisive  fossa, —  the  mental 
foramen  (below  the  root  of  the  second  bicuspid), —  the  ex- 
ternal oblique  line, —  a  subcutaneous  surface, —  the  groove 
for  the  facial  artery. 

The  Internal  Surface  presents  on  the  middle  line  the  sym- 
physis and  the  genial  tubercles, —  two  upper  and  two  lower. 

It  presents  on  either  side  —  the  fossa  for  the  sublingual 
gland, — the  digastric  fossa, —  the  internal  oblique  line  or 
mylohyoid  ridge, — the  submaxillary  fossa. 
The  Superior  Border  presents  the  alveoles  or  sockets  for 
the  teeth. 

The  Inferior  Border  or  Base  is  smooth, —  it  is  subcuta- 
neous. 

PERPENDICULAR  PORTIONS  OR  RAMI. 

281  The  External  Surface  gives  attachment  to  the  masseter 
muscle. 

The  Internal  Surface  presents  the  posterior  orifice  of  the 
interior  dental  canal, — the  spinous  process  for  internal  lat- 
eral ligament,  —  mylohyoid  groove, —  rough  surface  for  in- 
ternal pterygoid. 

The  Anterior  Border  is  partly  blended  with  the  horizontal 
portion. 

The  Upper  Border  presents  the  coronoid  process  for  the 
temporal  muscle, — the  sigmoid  notch, —  the  condyloid  pro- 
cess,—  presenting  on  the  neck  a  tubercle  for  the  external 
ligament, —  the  pterygoid  fossa. 

The    Posterior  Border  is   smooth, —  it  joins   the   inferior 
border  and  forms  the  angle  of  the  jaw. 
The  Inferior  Border  is  continuous  with  the  base. 


RESUME  OF  THE  SITUATION  OF  THE  BONES  OP  THE  HEAD.    97 

RESUME  OF  THE  SITUATION  OF  THE  BONES  OF  THE 
HEAD  AND  OF  THEIR  VARIOUS  PARTS. 

BONES  OP  THE  SKULL. 

282  On  the  Middle  Line,  from  before  backwards. 

The  frontal, —  the  plate  of  the  ethmoid, — the  body  of  the 
sphenoid, —  the   basilar   process   of    the   occipital    bone, — 
also  the  vertical  portion  of  the  occipital. 
On  the  Sides : 

The  lateral  portion  of  the  frontal  or  frontal  eminences, — 
the  horizontal  portion, —  the  vertical  portion, — the  Lesser 
wing*  of  the  sphenoid, —  the  lateral  mass  of  the  ethmoid. 
the  greater  wing, —  the  petrous  bone, —  the  parietal, —  the 
squamous  portion, —  the  mastoid, —  the  lateral  part  of  the 
horizontal  and  the  vertical  portion  of  the  occipital. 

BONES  OF  THE  FACE. 

283  The  Upper  Jaw  is  composed  of  thirteen  bones. 

They  form  four  rows. 
The    First  Row    is    formed  by    the  Vomer  alone  on   the 
middle  line. 

The  Second  Row  comprises  from  before  backwards,  the 
the  nasal,  lachrymal,  the  inferior  turbinated  and  the  palate. 
The  Third  Row  is  formed  by  one  bone  alone,  the  superior 
maxilla. 

The  Fourth  Row  is  also  formed  by  one  alone,  the  malar. 
N.  B. — All   the  bones   are   situated   to   the  inside  of    the 
superior  maxilla  except  the  malar. 

The  Superior  Maxilla  is  the  bone  of  the  face,  like  the 
sphenoid  is  the  bone  of  the  skull. 

It  articulates  with  all  the  bones  of  the  face  and  with  a 
number  of  bones  of  the  skull. 
The  Ethmoid  protrudes  into  the  nasal  cavities. 
The  Inferior  Turbinated   Bones  rest  on  the  inner  surface 
of  the  superior  maxilla. 

The  Palate  Bones  rest  on  the  posterior  surface  of  the 
superior  maxilla. 

The  Lower  Jaw  is  formed  bv  one  bone  only,  the  Lower 
•    Maxilla. 

SUTURES  OF  THE  SKULL. 

284  The  Sutures  of  the  Upper  Region  or  Vertex  are: 

On  the  middle  line, —  the  interfrontal, —  the  anterior  fonta- 
nelle, —  interparietal  or  sagittal. —  the  posterior  fontanelle. 

On  the  sides, —  the  fronto-parietal  or  coronal. —  parieto- 
occipital or  lambdoid. 
The    Sutures   of   the    Lateral    Surfaces    are    the    fronto- 


98  CRANIO -FACIAL   SUTURES — EXTERIOR   OF   SKULL. 

malar, —  malo-sphenoidal, —  splieno -frontal, —  sphenoparie- 
tal,—  spheno  -  squamous, —  parieto  -  mastoid, —  masto-occip- 
ital. 

The  Sutures  of  the  Base  or  Basilar  Sutures  are,  on  the 
middle  line,  the  occipito-sphenoidal. 

On  the  sides,  the  spheno-petrosal, —  sphenosquamous, — 
petro-squamous, —  occipito-petrosal, — occipito-mastoid. 

CRANIO-FACIAL  SUTURES. 

285  Have  received  no  special  names  except  the 
Transverse  Suture,  which  is  formed  by  the  junction  of  the 
frontal  with  the  facial  bones ; —  it  extends  from  the  exter- 
nal angle  or  orbital  process  on  one  side  to  the  opposite  side ; 
—  it  connects  the  frontal  with  the  nasal,  lachrymal,  supe- 
rior maxilla,  ethmoid,  sphenoid  and  malar  bones; — it  con- 
nects the  sphenoid  with  the  malar  bones  ; — it  connects  the 
malar  bone  to  the  zygomatic  process  of  temporal  bone. 

FACIAL  SUTURES. 
Have  no  special  names. 

EXTERIOR  OF  SKULL. 

286  Upper  Region  or  Vertex.  It  is  bounded, — in  front  by  the 
nasal  eminence  and  superciliary  ridges ; —  laterally  by  the 
temporal  ridges ; —  behind  by  the  external  occipital  pro- 
tuberance. 

It  presents  on  the  middle  line  —  the  nasal  eminence, —  the 
interparietal  suture  or  sagittal  suture. 

It  presents  on  the  sides — the  superciliary  ridges, — frontal 
eminences, — fronto-parietal  or  coronal  sutures — the  parietal 
eminences  —  and  the  parieto -occipital  or  lambdoid  sutures. 

287  Lateral  Region  of  Skull.  It  is  bounded  —  above  by  the 
curved  line  of  the  temporal  bone; — in  front  by  a  line  ex- 
tending from  the  external  angular  process  of  the  frontal  to 
the  angle  of  the  jaw; — behind  by  a  line  from  the  extremity 
of  the  superior  curved  line  to  the  angle  of  the  jaw. 

288  1st.  Mastoid  Region  :  It  is  bounded  —  in  front  by  the  ante- 
rior root  of  the  zygoma, —  above  by  a  line  drawn  from  the 
posterior  root  of  the  zygoma  to  the  end  of  the  masto-pari- 
etal  suture  ; —  and  below  by  the  masto-occipital  suture. 

It  presents: — A  part  of  the  squamous  bone, —  the  mastoid 
process, —  the  mastoid  foramen, —  the  articular  eminence, 
the  glenoid  fossa, —  the  glenoid  fissure, —  and  the  external 
auditory  meatus. 

289  2d.  Temporal  Fossa:  It  is  bounded  —  in  front,  above  and 
behind  by  the  temporal  ridge, —  externally  by  the  zygomatic 
arch, —  internally  by  the  pterygoid  ridge. 

It  is  formed  by  the  frontal,  malar,  parietal,  temporal  and 
sphenoid  bones. 


INFERIOR   REGION   OR    EXTERIOR   OF   THE    BASE   OF   SKULL.      99 

Its-  sutures  are  the   transverse   facial,   coronal,    spheno- 
parietal, squaino-parietal,  squamo-sphenoidal. 
290  3d.  Zygomatic   Fossa:    It   is   bounded  —  in  front   by  the 

tuberosity  of  the  superior  maxilla. —  behind  by  posterior 
border  of  the  pterygoid  process, —  above  by  the  pterygoid 
ridge, — belowhy  the  alveolar  border  of  the  superior  maxilla, 

—  internally  by  the  external  plate  of  the  pterygoid  process, 

—  externally  by  the  zygomatic  arch  and  ramus  of  the  jaw. 

Tt presents  the  spheno-maxillary  fissure, —  and  th»j  ptery- 

go-maxillary  fissure. 

291' 4th.   Maxillary  Fossa  (or  Pterygo=Maxillary  Fossa):    It 

is  bounded  —  in  front  by  the  superior  maxilla, —  behind  by 

the  pterygoid  process, —  above  by  the  body  of  the  sphenoid, 

—  internally  by  the  vertical  plate  of  the  palate  bone. 

It  presents  three  fissures,  the  sphenoidal,  spheno-maxillary 
and  pterygo-maxillary ; — five  orifices:  one  internal,  the 
spheno-palatine ;  three  posterior,  the  round,  the  vidian,  and 
the  pterygo-palatine ;  one  inferior,  the  posterior  palatine 
canal  or  maxillo-palatine. 

It  communicates  with  four  rarities,  the  orbital,  nasal, 
cranial  and  zygomatic. 

INFERIOR  REGION  OR  EXTERIOR  OF  THE  BASE 
OF  SKULL. 

292  It  is  bounded  —  in  front  by  the  incisor  teeth  of  the  upper 
jaw  ; — laterally  by  the  alveolar  arch,  lower  border  of  malar, 
a  line  from  the  zygoma  to  the  mastoid  process  and  extremity 
of  the  superior  curved  line  ; —  behind  by  the  superior  curved 
line  of  the  occipital  bone. 

It  presents  several  regions. 

293  1st.  Palato=Pterygoid  Region  :  It  presents  on  the  middle 
line, —  the  anterior  palatine  canal,  for  vessels  and  nerves  of 
the  same  name, —  the  articulation  of  the  palate  processes  of 
the  superior  maxilla, —  the  articulation  of  the  horizontal 
plates  of  the  palate  bones, —  the  posterior  border  of  the 
vomer. 

It presents  on  the  sides, —  the  alveolar  process. —  the  in- 
ferior surface  of  the  palate  processes  of  the  superior  max- 
illa,— the  inferior  surface  of  the  horizontal  plate  of  the 
palate  bone, —  the  posterior  nares, —  the  hamular  process 
for  the  reflection  of  the  tensor  muscle  of  the  palate. —  and 
inner  lamina  of  pterygoid  process, —  the  pterygoid  fossa. 
for  insertion  of  the  internal  pterygoid  muscle, —  the  outer 
lamina  of  the  pterygoid  proeess  for  insertion  of  external 
pterygoid  muscle, —  the  scaphoid  fossa  for  insertion  of  the 
tensor  muscle  of  the  palate. —  the  pterygoid  or  vidian  canal. 

294  2d.  The  Occipital  Region  presents  on  the  middlt  Mm  — the 
sphenooccipital  suture, — the  basilar  process, —  the  occipital 
foramen  for  oblong  medulla  and  vertebral    arteries, —  the 


100  ANTERIOR  REGION   OF   SKULL:    FACE — ORBITS. 

external  occipital  crest  for  the  nuchal  ligament, —  the 
external  occipital  protuberance. 

It  presents  on  the  sides  —  the  anterior  condyloid  fossa  and 
foramen  for  the  hypoglossal  nerve, —  the  occipital  condyle 
articulating  with  the  atlas, —  the  posterior  condyloid  fossa 
and  foramen  for  a  small  vein, —  the  under  surface  of  occip- 
ital for  muscular  attachment, —  the  inferior  curved  line  for 
same, —  and  the  superior  curved  line  for  same. 

295  3d.  The  Sphenoidal  Region  presents  —  the  under  surface 
of  the  greater  wing  forming  —  the  roof  of  the  zygomatic 
fossa  —  the  oval  foramen  for  inferior  maxillary  nerve; — 
the  spinous  foramen  for  middle  meningeal  artery,  — the 
spinous  process  of  sphenoid. 

296  4th.  The  Petrous  Region  presents  —  the  petro- sphenoidal 
articulation  —  and  middle  lacerated  foramen  (formed  by 
the  articulation  of  apex  of  petrous  bone  with  the  body  of 
sphenoid  and — by  articulation  of  anterior  border  of  petrous 
bone  with  posterior  border  of  greater  wings), —  the  canal 
for  the  Eustachian  tube, — a  rough  surface  for  muscular  at- 
tachment,—  the  inferior  orifice  of  carotid  canal, — the  vagi- 
nal process, —  the  posterior  glenoid  cavity, —  the  auricular 
process, —  the  external  auditory  meatus, —  the  petro-occipi- 
tal  foramen  or  posterior  lacerated  foramen  (with  jugular 
foramen  for  jugular  vein,  glosso-pharyngeal,  pneumo-gas- 
tric  and  spinal  accessory  nerves), — the  styloid  process  for 
attachment  of  stylian  muscles  and  ligaments —  and  the 
stylo -mastoid  foramen  for  facial  nerve. 

297  5th.  The  Squamous  Region  presents  —  the  sphenosquam- 
ous suture, —  the  anterior  root  of  zygoma  with  articular  em- 
inence,—  the  glenoid  fossa  which  articulates  with  the  con- 
dyle of  the  inferior  maxilla, —  the  glenoid  fissure  which 
lodges  the  laxator  muscle  of  tympanum,  cord  of  the  tym- 
panum, and  slender  process  of  the  malleus. 

6th.  The  Mastoid  Region  presents — the  occipito-mastoid 
suture, —  the  mastoid  foramen  for  a  vein  to  lateral  sinus, — 
a  groove  for  the  occipital  artery, —  the  digastric  groove  for 
digastric  muscle, —  the  mastoid  process  for  sterno-mastoid 
muscle. 

ANTERIOR  REGION  OF  SKULL:     FACE— ORBITS. 

298  The  Orbits  are  formed  by  seven  bones :  frontal,    ethmoid, 
sphenoid,  superior  maxillary,  lachrymal,  palate,  malar. 
The  Roof  is  formed  by  the  frontal  and  lesser  wing  of  sphe- 
noid.—  It  presents —  a  depression  for  the  pulley  of  the  su- 
perior oblique  muscle  —  and  one  for  lachrymal  gland. 

The  Floor  is  formed  by  the  superior  maxillary,  malar  and 
palate  bones. — It  presents  a  depression  for  insertion  of  in- 
ferior oblique  muscle  —  and  the  infra-orbital  groove, 
The  Inner  Wall   is   formed   by  the   lachrymal,    ethmoid, 


ANTERIOR   REGION   OF   SKULL:    FACE — ORBITS.  lUJ 

sphenoid  and    palate  bones. —  It    presents   the   lachrymal 

groove  and  the  lachrymal  crest . 

The  Outer   Wall    is    formed   by  the   malar   and    sphenoid 
bones. —  It  presents  the  orifices  of  the  two  malar  canals. 
The  Superior  Internal   Angle   presents  —  the  fronto-lach- 
rymal    suture, —  the     fronto-ethmoidal    suture, —  the    eth- 
moidal foramina. 
The  Superior  External  Angle  presents  —  the  fronto-malar 

—  and  fronto-sphenoidal  sutures, —  and  the  sphenoidal  fis- 
sure or  anterior  lacerated  foramen. 

The  Inferior  Internal  Angle  presents  —  the  .sutures  of  the 
lachrymal  and  superior  maxillary  bones  —  and  of  the  eth- 
moid and  palate  bones. 

The  Inferior  External  Angle  presents  the  sphenomaxil- 
lary fissure. 

The  Circumference  or  Base  of  Orbit  is  bounded  —  inter- 
nally, by  the  nasal  process  of  the  superior  maxillary  bone 
and  the  internal  angular  process  of  the  frontal  with  the 
lachrymal  canal ; —  above,  by  the  supra-orbital  arch  with 
foramen; — externally,  by  the  external  angular  processes  of 
frontal  and  malar  bones; — and  below,  by  the  malar  bone 
and  superior  maxilla. 

The  Apex  presents  the  optic  foramen,  formed  by  the  small 
wing-  of  the  sphenoid. 
299  2d.  Nasal  Fossae.  Boundaries :  The  Nasal  Fossa1  are 
formed  by  fourteen  bones: — three  of  the  cranium,  frontal, 
ethmoid  and' sphenoid, —  and  all  the  bones  of  the  face,  ex- 
cept the  malar  and  inferior  maxillary. 

The  Roof  is  formed  by  the  nasal  bones,  nasal  spine  of 
frontal,  cribriform  plate  of  ethmoid  and  sphenoidal  turbi- 
nated bones. 

The  Floor  is  formed  by  the  palate  process  of  the  superior 
maxillary, —  and  the  horizontal  plates  of  the  palate  bones. 

It  presents  —  the  orifice  of  anterior  palatine  canal. 
The  Inner  Wall  is  formed  by  the  ethmoid,  vomer  and  sep- 
tal cartilage. 

The  Outer  Wall  is  formed  by  the  nasal  process,  lachrymal 
bone,  ethmoid,  superior  maxilla  and  vertical  plate  of  palate 
bone. 

It  presents  —  the  surface  for  the  filaments  of  the  olfact- 
ory nerve, —  the  superior  turbinated  bone. — the  superior 
meatus  with  ethmoid  and  sphenoid  openings. —  the  middle 
meatus  with  openings  of  the  antrum, —  the  inferior  turbi- 
nated bone,  the  inferior  meatus  and  orifice  of  nasal  canal. 
The  Posterior  Nares  are  bounded  —  nhun  by  the  sphenoid, 

—  internally  by  the  vomer, — externally  by  vertical  plate  of 
palate  bone, —  below  by  the  horizontal  plate. 

The  Anterior  Nares  are  bounded  by  the  superior  maxillary 
and  nasal  bones. 


102  INTERIOR    OF    SKULL   AS   A   WHOLE. 


INTERIOR  OF  SKULL  AS  A  WHOLE. 

300  Divisions  :  Upper  Region  or  Roof,  and  Lower  Region  or 
Base. 

Boundaries  :  Circular  line  passing  one  inch  above  nasal 
eminence  of  frontal — and  behind  one  inch  above  external 
occipital  protuberance. 

301  The  Upper  Region  or  Roof  presents,  on  the  middle  line — 
the  frontal  crest, — the  inter-frontal  and  sagittal  sutures, — 
the  groove  for  the  superior  longitudinal  sinus, — the  Pac- 
chionian depressions. 

On  the  sides  : — the  parietal  fossa, — the  arterial  grooves, 

—  the  depressions  for  convolutions, —  the  coronal  or  fronto- 
parietal suture, —  the  lambdoid  or  parietooccipital  suture. 
The  Base  presents  the  anterior,  middle,  and  posterior  cere- 
bellar fossa?. 

302  Anterior  or  Frontal  Cerebral  Fossa : 

It  is  formed  by  the  cribriform  plate  of  the  ethmoid,  the 
frontal,  and  small  wings  of  sphenoid. 

It  presents  on  the  middle  line  —  the  frontal  crest, — the 
blind  foramen,  the  surface  of  the  grey  root  of  the  optic 
nerve. 

It  presents  on  the  sides  —  the  olfactory  grooves  with  the 
foramina  of  the  cribriform  plate,  eminences  and  depressions 
for  convolutions. 

303  Middle  or  Sphenoidal  Cerebral  Fossa: 

It  is  formed  by  the  body  of  the  sphenoidal  greater  wings, 

—  squamous  portion  of  temporal  bone, —  and  anterior  sur- 
face of  petrous  portion. 

It  presents  on  the  middle  line  the  olivary  process  —  and 
the  pituitary  foss.a. 

It  presents  on  the  sides  —  the  optic  foramina — the  anterior 
and  posterior  clinoid  processes  giving  attachment  to  the 
tentorium,— the  groove  for  cavernous  sinus, — the  sphe- 
noidal fissure  giving  passage  to  the  ophthalmic  vein,  the 
third,  the  fourth,  the  first  branch  of  the  fifth,  and  the  sixth 
nerves; — the  round  foramen  for  superior  maxillary  nerve, 

—  the  spinous  foramen  for  middle  meningeal  artery, — the 
oval  foramen  for  inferior  maxillary  nerve, — the  middle  lac- 
erated foramen  for  arterioles  and  the  petrosal  nerves ; — the 
internal  orifice  of  the  carotidian  canal, — the  depression  for 
the  Casserian  ganglion, — the  groove  for  small  petrosal 
nerve, — the  projection  of  superior  semi-circular  canal, —  the 
roof  of  tympanum, — the  groove  for  superior  petrosal  sinus, 

—  the  eminences  and  depressions  for  convolutions  —  and 
grooves  for  arteries. 

304  The  Posterior  or  Occipital  or  Cerebellar  Fossa: 

It  is  formed  by  the  occipital  bone, — posterior  surface  of 
petrous  bone  —  and  a  small  portion  of  the  parietal. 

It  presents  on  the  middle  line — the  basilar  groove  for  the 


FORAMENS  OF  THE  BASF  OF  THE  ENTEBIOK  OF  THE  SKULL.      103 

oblong  medulla, —  the  occipital  foramen  wild   the  anterior 
condyloid  foramen, — the  occipital  crest  for  cerebellar   t'alx. 

—  the  internal  occipital  protuberance  for  cerebral   falx. — 
the  depression  for  the  press  of  Herophilus. 

On  the  sides — the  internal  auditory  meal  us  for  the  facial 
and  the  auditory  nerves, —  the  depressions  for  the  convolu- 
tions, the  posterior  lacerated  foramen  or  jugular  foramen 
or  occipito -petrosal  suture, —  the  termination  of  lateral  si- 
nuses,— the  masto-occipital  surface, — the  cerebellar  fossa. — 
the  beginning  of  lateral  sinuses. 

FORAMENS  OF  THE  BASE  OF  THE   INTERIOR  OF  THE 
SKULL  AND  ORGANS  SITUATED   THEREIN. 

305  Anterior  or  Frontal  Cerebral  Fossa. 

On  the  Middle  Line — Blind  foramen,  so-called,  for 
venule  anastomosing  with  the  superior  longitudinal  sinus. 

On   the  Sides — Cribriform  plate  of  the  ethmoid,   giving 
passage  to  the  filaments  of  the  olfactory  nerves. 
Middle  of  the  Sphenoidal  Cerebral  Fossa. 

Ou  the  Middle  Line —  Pituitary  fossa. 

On  the  Sides — Optic  foramen  for  optic  nerve  and  ophthal- 
mic artery. 

Sphenoidal  Fissure  (or  Anterior  Lacerated  foramen),  giv- 
ing passage  to  the  ophthalmic  vein,  the  third,  the  fourth,  the 
first  branch  of  the  fifth  and  the  sixth  cranial  nerves. 

Cavernous  sinus, — giving  passage  to  the  internal  carotid 
artery  and  the  nerves  just  mentioned. 

Round  foramen,  for  the  fifth  Superior  Maxillary  nerve. 

Spinous  foramen,  for  the  Middle  Meningeal  artery. 

Oval  foramen,  for  the  Inferior  Maxillary  nerve. 

Middle  Lacerated  Foramen  (spheno-petrosal  suture),  giv- 
ing passage  to  arterioles  and  to  petrosal  nerves. 

Internal  Orifice  of  Carotidean  Canal  for  Internal  Carotid 
Artery. 

Groove  for  Superior  Petrosal  Sinus. 
Posterior  or  Occipital  or  Cerebellar  Fossa. 

On  the  Middle  Line  —  Occipital  foramen,  giving  passage  to 
the  oblong  medulla  —  the  spinal  accessory  —  the  vertebral 
arteries. 

On  the  Sides  —  Anterior  Condyloid  foramen  for  the  hypo- 
glossal nerve. 

Internal  Auditory  Canal  for  the  auditory,  the  facial  and 
the  nerve  of  Wrisberg. 

Groove  for  Inferior  Petrosal  Sinus. 

Posterior  or  Lacerated  Foramen  or  Jugular  Foramen  (/'.<.. 
Occipito-petrosal  suture ) . 

Jugular    vein  —  the    glossopharyngeal  —  pneumo-gastric 

—  spinal  accessory. 

Mastoid  Foramen  for  mastoid  vein. 
Lateral  Sinuses,  with  Press  of  Herophilus. 


104      POINTS  CONCERNING  THE  RIBS,  STERNUM  AND  CLAVICLE. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  RIBS. 

30G  Number:  There  are  Twelve  Ribs  on  each  side. 

Division  :  There  are  seven  true  or  vertebro-costal  ribs,  three 
false  or  vertebro-chondral  ribs,  and  two  floating  ribs. 
Direction  :  The  ribs  are  twisted. 

The  Head  presents  two  facets  for  articulation  with  the  ver- 
tebrae. 

The  Neck  presents  on  its  upper  border  a  crest  for  the  costo- 
transverse ligament. 

The  Tuberosity  presents  a  facet  for  articulation  with  the 
transverse  process  of  a  vertebra. 
The  Angle  of  the  Rib  is  a  marked  ridge. 
The  Inferior  Border  of  the  body  is  grooved  for  the  inter- 
costal vessels  and  nerves. 

The  Anterior  Extremity  articulates  with  the  costal  car- 
tilage ; — this  extremity  is  lower  than  the  posterior  extrem- 
ity, corresponding  horizontally  behind  to  the  head  of  the 
second  rib  above  it. 

307  First  Rib:  The  head  presents  a  single  facet, — it  presents 
the  scalene  tubercle, —  a  groove  for  the  subclavian  artery — 
and  also  one  for  the  vein ; — there  is  no  angle  or  twist. 
Second  Rib:  It  presents  a  roughness  for  the  posterior  sca- 
lene and  the  great  serrate  muscles. 

Tenth  Rib:  It  presents  a  single  facet  on  the  head. 
Eleventh  Rib:  It  presents  a  single  facet  on  the  head; — it 
has  no  tuberosity; — the  anterior  extremity  is  pointed. 
Twelfth  Rib:  It  presents  a  single  facet  on  the  head; — it 
has  no  neck, —  no  tuberosity, —  no  groove ; — it  has  a  pointed 
extremity. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  STERNUM. 

308  Divisions..  The  Sternum  is  divided  into  the  handle  or  first 
piece,  the  blade  or  second  piece; — the  articulation  of  the  two 
pieces  persists  sometimes  late  in  life. — The  ensiform  cartilage 
is  the  point  or  third  piece. 

It  presents  articular  facets  for  the  costal  cartilages  and  for 
the  clavicle. 

The  Posterior  Surface  is  in  relation  with  the  innominate  ves 
sels,  pericardium  and  heart. 

RESUME  OF  THE   POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  CLAVICLE. 

309  1st,  a  facet  to  articulate  with  the  sternum ; — 2d,  a  tubercle 
for  the  attachment  of  the  sterno-mastoid  muscle  and  inter- 
clavicular ligament ; — 3d,  a  roughness  for  the  costo-clavicu- 


POINTS  CONCERNING  THE  SCAPULA,  HUMERUS  AND  ULNA.       L05 

lar  ligament; — 4th,  a  roughness  of  the  subclavian   muscle  ; 

—  5th,  convexity  in  front  for  attachment  of  great  pectoral 
muscle  —  and  also  a  concavity  for  the  origin  of  the  deltoid ; 
6th,  concavity  behind  for  attachment  of  sterno-mastoid ; — 

7th,  also  convexity  for  the  attachment  of  the  trapezius ; — 
8th,  a  facet  for  articulation  with  the  acromion ; — 9th,  ;i 
roughness  of  the  costo-clavicular  ligaments. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  SCAPULA. 

310  The  Scapula  presents:  1st,  the  subscapular  fossa  ; — I'd.  the 
supra-spinal  fossa; — 3d,  the  spine  of  the  scapula — and 
acromion; — 4th,  the  infra-spinous  fossa; — 5th,  the  cora- 
coid  process — for  coraco-brachial,  small  pectoral  and  short 
head  of  the  biceps  ; —  6th,  the  origin  of  the  long  head  of  the 
biceps  ; — 7th,  the  glenoid  cavity ; —  8th,  a  roughness  for  the 
origin  of  long  head  of  the  triceps  ; — 9th,  an  axillary  border  j 
— 10th,  a  spinal  border; — 11th,  a  superior  or  coracoid  bor- 
der. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  HUMERUS. 

311  They  are: — 1st,  the  head,  which  articulates  with  the  glenoid 
cavity; — 2d,  the  anatomical  neck  for  the  insertion  of  the 
capsular  ligament; — 3d,  the  lesser  tuberosity  for  the  inser- 
tion of  the  subscapular; — 4th,  the  greater  tuberosity  with 
three  facets  for  the  insertion  of  the  supra-spinous.  infra- 
spinous,  and  small  round; — 5th,  the  bicipital  groove  for 
the  long  head  of  biceps,  the  anterior  ridge  for  great  pectoral ; 

—  6th,  the  surgical  neck; — 7th,  the  roughness  for  the  del- 
toid;—  8th,  the  musculo-spiral  groove  for  the  profunda 
artery  and  the  musculo-spiral  nerve  ; — 9th,  an  outer  border ; 

—  10th,  an  inner  border; — 11th,  the  olecranon  fossa: — 
12th,  the  coronoid  fossa; — 13th,  the  internal  condyle; — 
14th,  the  trochlea  for  the  ulna; — 15th,  the  groove  for  the 
edge  of  the  head  of  the  radius; — 16th.  the  small  head  of 
the  humerus  for  the  head  of  the  radius  ; — 17th,  the  external 
condyle. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  ULNA. 

312  They  are: — 1st,  the  olecranon  process; — 2d.  the  coronoid 
process; — 3d,  the  greater  sigmoid  notch  or  cavity  articulat- 
ing with  the  humerus; — 4th,  the  lesser  sigmoid  notch  artic- 
ulating with  the  radius; — 5th,  the  roughness  for  the  an- 
terior brachial  muscle; — 6th,  the  outer  border  for  the 
insertion  of  the  interosseous  ligament; — 7th.  the  neck   of 


106  POINTS  CONCERNING  THE  RADIUS,  CARPUS  AND  METACARPUS. 

the  ulna; — 8th,  the  head  of  the  ulna  articulating  below 
with  the  triangular  fibro-cartilage,  cuneiform  bone  and  on 
the  side  with  the  radius; — 9th  the  styloid  process  for  inter- 
nal lateral  ligament; — 10th,-  the  groove  for  the  insertion  of 
the  triangular  ligament. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  RADIUS. 

313  They  are: — 1st,  the  head  articulating  above  with  the  small 
head  of  the  humerus  —  and  laterally  with  the  lesser  sigmoid 
notch  of  the  ulna; — 2d,  the  neck  of  the  radius; — 3d,  the 
bicipital  tubercle  for  the  tendon  of  the  biceps; — 4th,  the 
oblique  line; — 5th,  the  roughness  for  the  round  pronator; 
—  6  th,  the  inner  border  for  the  interosseous  ligament; — 7th, 
the  supinator  tubercle  ; — 8th,  the  lower  extremity  articulat- 
ing with  the  semilunar  and  scaphoid  bones  ; — 9th,  the  artic- 
ular facet  for  the  head  of  the  ulna; — 10th,  the  styloid  pro- 
cess for  the  external  lateral  ligament; — 11th,  the  grooves 
for  the  tendons. 

RESUME  OP  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  CARPUS. 

314  The  Carpus  is  composed  of  two  rows  of  bones. 

The  First  Row  comprises — the  scaphoid,  resembling  a  boat 
and  articulating  with  the  radius  ; — the  semilunar,  resembling 
a  crescent  and  articulating  also  with  the  radius; — the 
cuneiform  or  pyramidal,  resembling  a  wedge  and  articulating 
with  the  fibro-cartilage  and  ulna; — the  jiisi form,  resembling 
a  pea,  articulating  with  the  cuneiform  and  giving  attach- 
ment to  the  ulnar  carpal  flexor. 

The  Second  Row  comprises  —  the  trapezium,  articulating 
with  the  metacarpal  bone  of  the  thumb; — the  trapezoid, 
smaller  than  the  trapezium ; — the  os  magnum,  projecting 
upwards  between  the  scaphoid  and  the  semilunar; — the 
unciform  bone,  having  a  hook-like  process  for  the  attach- 
ment of  the  annular  ligament. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  METACARPUS. 

315  They  are: — 1st,  facets  for  articulation  with  the  carpal 
bones  ; — 2d,  lateral  facets  for  articulation  with  one  another; 
— 3d,  an  anterior  border  for  tendinous  insertions; — 4th,  a 
head  articulating  with  the  first  phalanx  ; —  5th,  lateral  tuber- 
cles for  the  insertion  of  the  lateral  ligaments. 

The  first  metacarpal  hone  or  metacarpal  bone  of  the  thumb 
has  no  lateral  facets  and  does  not  articulate  with  the  others. 
The  last  metacarpal  bone  presents  no  inner  lateral  facet. 


POINTS  CONCERNING  THE  PHALANGES  AND  [NNOMINATE  BONE.    10/ 

RESUME  OF  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  FIRST  PHALANGES. 

31G  They  are: — 1st,  a  cavity  articulating  with  the  head  of  tin* 
metacarpal  bones; — 2d,  a  rough  surface  for  the  insertion  of 
the  sheath  of  the  flexor  tendons; — 3d.  the  lower  extremity 
presents  the  shape  of  a  small  pulley  or  trochlea,  i.  <.,  two 
small  eminences  or  heads  separated  by  a  groove  ; —  it  articu- 
lates with  the  second  phalanx. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEKEST 
CONCERNING  THE  SECOND  PHALANGES. 

The  Upper  Extremity  presents  two  small  cavities  sepa- 
rated by  a  ridge  and  articulates  with  the  first  phalanx ; — 
rough  borders  for  the  insertion  of  the  tendons  of  the  super- 
ficial flexor. 

The  Lower  Extremity  presents  a  pulley. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  THIRD  PHALANGES. 

The  Tipper  Extremity  presents  two  small  cavities  separated 
by  a  ridge. 

The  Lower  Extremity  has  the  shape  of  a  horseshoe — and 
is  rough  for  the  insertion  of  the  deep  flexor. 

The  Thumb  has  no  second  phalanx. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  INNOMINATE  BONE. 

317  Divisions.  It  comprises  three  portions,  the  Ilium.  Pubis 
and  Ischium. 

The  Outer  Surface  presents  the  superior  curved  line  : — a 
rough  surface  for  the  great  gluteal; — the  middle  curved 
line; — a  rough  surface  for  the  middle  gluteal ; — the  infe- 
rior curved  line  ; — a  rough  surface  for  the  small  gluteal ; — 
a  groove  for  the  reflected  tendon  of  straight  femoral 
muscle; — the  acetabulum  for  the  reception  of  the  head  of 
the  femur; — the  back  cavity  of  the  acetabulum  not  lined 
with  cartilage  and  lodging  the  round  ligament  ; — the  acetab- 
ular or  cotyloid  notch; — the  obturator  foramen; — the 
obturator  canal; — a  groove  for  the  tendon  of  the  internal 
obturator; — the  tuberosity  of  the  ischium. 
The  Inner  Surface  presents  —  a  rough  surface  tor  liga- 
ments,—  the  auricular  facet  articulating  with  the  sacrum  ;  — 
the  internal  iliac  fossa. —  the  brim  of  the  pelvis, — a  square 
surface  corresponding  to  the  acetabulum; — the  obturator 
canal  and  the  obturator  foramen. 


108  POINTS   CONCERNING   THE   PELVIS  IN   GENERAL. 

The  Upper  Border  or  Iliac  Crest  gives  attachment  to  the 
oblique  and  transverse  muscles. 

The  Anterior  Border  presents  the  anterior  superior  spinous 
process  for  the  sartorius  and  Poupart's  ligament; — a 
notch; — the  anterior  inferior  spinous  process  for  the 
straight  femoral  muscle; — a  notch; — the  pectineal  emi- 
nence;—  the  horizontal  branch  of  the  pubis; — the  ilio- 
pectineal  line; — the  spine  of  the  pubis; — the  crest  of  the 
pubis  ; — the  angle  of  the  pubis. 

The  Internal  Border  presents  the  descending  branch  of  the 
ischium  for  the  origin  of  the  cavernous  bodies  and  the  great 
adductor. 

The  Posterior  Border  presents  —  the  tuberosity  of  the 
ischium, —  the  lesser  sacro-sciatic  notch ; —  the  spine  of  the 
ischium, —  the  greater  sacro-sciatic  notch; — the  posterior 
inferior  spinous  process; — the  posterior  superior  spinous 
process. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  PELVIS  IN  GENERAL. 

318  The  Upper  Strait  or  Inlet  is  limited  —  behind  by  the 
sacrum, —  laterally  by  the  pelvic  brim  of  the  innominate 
bone  —  and  in  front  by  the  pubis. 

The  Diameters  are  the  antero-posterior,  from  sacro -vertebral 
angle  to  pubic  symphysis, —  the  transverse  or  bi-iliac; — the 
oblique,  extending  from  pectineal  eminence  to  opposite  sacro- 
iliac symphysis. 

The  Upper  Plane  is  the  surface  included  by  those  limits. 
The  Axis  of  the  Upper  Strait  is  the  line  passing  perpen- 
dicularly through  the  centre  of  the  upper  strait; — it  is 
directed  backwards  and  downwards  ; —  the  upper  extremity 
of  the  line  corresponds  to  the  umbilicus, —  the  lower  ex- 
tremity to  the  lower  part  of  the  concavity  of  the  sacrum. 
The  Lower  Strait  or  Outlet  is  limited — behind  by  the 
sacrum  and  coccyx ; —  laterally  by  the  great  sacro-sciatic  liga- 
ment ; —  anteriorly  by  the  arch  of  the  pubis  and  the  ischium. 
The  Diameters  are  antero-posterior  or  coccy-pubic,  trans- 
verse or  bi-ischiatic. 

The  Lower  Plane  is  the  surface  included  by  those  limits. 
The  Axis  of  the  Lower  Strait  is  the  line  passing  per- 
pendicularly through  the  centre  of  the  lower  plane; — it  is 
directed  backwards  and  upwards; — it  corresponds  to  the 
axis  of  the  vagina ; —  its  upper  extremity  corresponds  to  the 
upper  part  of  the  sacrum. 

RESUME  OF  THE  DIFFERENCES  BETWEEN  THE  MALE 
AND  FEMALE  PELVIS. 

319  In  the  Male  pelvis  the  vertical  diameters  are  the  longest 
and  the  horizontal  are  the  shortest. 


POINTS  CONCERNING  THE  FEMUR,  PATELLA  AND  TIBIA.         109 

In  the  Female  Pelvis  the  antero-posterior  and  the  trans- 
verse diameters  are  the  longest  and  the  vertical  the  shortest. 

In  Short,  the  Female  pelvis  is  wider  but  lower; — whereas 
the  male  pelvis  is  narrower  but  higher. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  FEMUR. 

320  They  are  : — 1st,  the  head,  articulating  with  the  acetabulum 
and  presenting  a  depression  for  the  round  ligament ; —  2d, 
the  neck,  which  is  intracapsular  in  front  but  extracapsular 
behind; — 3d,  the  small  trochanter; — 4th,  the  anterior  in- 
tertrochantic  line  or  spiral  line ; —  5th,  the  great  trochanter 
for  the  pelvic  muscles ; —  6th,  the  digital  depression  for  the 
internal  obturator; — 7th,  the  inner  upper  branch  of  rough 
line  to  great  trochanter ; — 8th,  the  outer  upper  branch  of 
rough  line  to  great  trochanter; — 9th,  the  rough  line  of  the 
femur  for  the  adductor  muscles ; —  10th,  the  inner  lower 
branch  of  the  rough  line  with  the  tubercle  for  the  great  adduc- 
tor ; — 11th,  the  outer  lower  branch  of  the  rough  line  ; — 12th, 
the  condyles, — united  in  front — and  separated  behind  by  the 
intercondyloid  notch  for  the  spine  of  tibia  and  the  insertion 
of  the  crucial  ligaments; — 13th,  the  outer  tuberosity; — 
14th,  the  groove  for  the  popliteus,  and, —  15th,  the  inner 
tuberosity  with  the  tubercle  for  the  tendon  of  the  great 
adductor. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  PATELLA. 

321  The  Posterior  Surface,  the  upper  two-thirds  of  which  are 
lined  with  articular  cartilage ;  the  lower  third  is  not,  and  is 
out  of  the  joint. 


RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  TIBIA. 

322  They  are  : — 1st,  the  head  presents  the  glenoid  cavities  ; —  2d, 
the  spine  of  the  tibia  for  the  insertion  of  the  cross  liga- 
ments ; — 3d,  the  internal  tuberosity; — 4th,  the  groove  for 
the  semi-membranous; — 5th,  the  external  tuberosity  —  6th, 
a  facet  articulating  with  the  fibula; — 7th,  the  tubercle  of 
the  tibia; — 8th,  the  anterior  border  or  shin; — 9tb,  the  ex- 
ternal border  or  interosseous  ridge; — 10th,  the  space  for 
popliteal  muscle ; — 11th,  the  oblique  line; — 12th,  the  in- 
ternal malleolus; — 13th,  the  posterior  grooves  for  the  ten- 
dons;—  14th,  the  facet  for  articulation  with  the  fibula;  — 
15th,  the  facet  for  articulation  with  the  astragalus. 


110   POINTS  CONCERNING  THE  FIBULA  AND  TARSUS — LIGAMENTS. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  FIBULA. 

323  They  are  : —  1st,  the  head,  presenting  the  styloid  process  and 
a  facet  articulating  with  the  tibia; — 2d,  the  neck; — 3d,  the 
internal  border  or  interosseous  ridge ; — 4th,  the  external 
malleolus, —  a  rough  surface  for  the  interosseous  ligament; 
—  an  articular  facet  for  the  astragalus  —  and  depressions 
for  the  lateral  ligament. 

RESUME  OF  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  TARSUS. 

324  The  First  Row  comprises  the  Astragalus  and  the  Cal- 
caneum. 

The  Astragalus  presents  —  a  head  articulating  with  sca- 
phoid,— a  neck, —  facets  for  articulation  with  the  tibia  and 
malleoli  and  with  the  two  upper  facets  of  calcaneum;  —  a 
groove  between  these  two  facets  for  the  interosseous  liga- 
ment,— depression  on  the  posterior  surface  for  the  external 
lateral  ligament, —  a  groove  for  the  long  flexor  of  the  great 
toe. 

The  Calcaneum  presents — articular  facets  for  the  astraga- 
lus —  a  groove  between  the  two ; —  the  lesser  process  of  the 
calcaneum, — the  greater  process  of  the  calcaneum, —  the  in- 
ner tuberosity, —  the  outer  tuberosity, —  the  tubercle  (on 
external  surface)  for  the  external  lateral  ligament, — grooves 
for  the  peroneal  muscles  separated  by  a  ridge. 

325  The  Second  Row  comprises  the  scaphoid,  the  three 
cuneiforms  and  the  cuboid. 

The  Scaphoid  presents — an  anterior  surface  articulating 
with  the  astragalus; — articular  surfaces  for  the  three 
cuneiforms; — the  tubercle  of  the  scaphoid  for  the  insertion 
of  the  tarsal  ligament. 

Cuneiforms.  The  internal  cuneiform  is  the  largest,  the 
middle  is  the  smallest,  and  the  external  the  middle-sized  one. 

They  present  articular  facets  for  articulation  with  the  sca- 
phoid, with  one  another  and  with  the  metatarsal  bones. 

The  Cuboid  presents  articular  facets  for  the  calcaneum 
and  the  last  two  metatarsals  ; — a  groove  for  the  tendon  of 
the  long  peroneal  muscle. 

Metatarsal  Bones  and  Phalanges :  Same  as  in  the 
fingers. 

LIGAMENTS. 

326  Structure.  The  Simple  Fibrous  are  formed  of  white  tissue 
alone. 

The  Fibro-Elastic  have  more  or  less  elastic  fibres. 

The  Elastic  are  formed  of  elastic  fibres  alone  (yellow  elastic 

ligaments  between  the  lamina?  of  the  vertebras). 


SEROUS   MEMBRANES — CLASSIFICATION    OF  JOINTS.  Ill 

The  Fibro- Cartilaginous  have  more  or  less  cartilaginous  t is 

sue  in  them  (intervertebral  discs). 

The  Cartilaginous  have   no   fibres   in   them  (synarthrodia] 

joints). 

SYNOVIAL   AND   SEROUS   MEMBRANES    IX    GENERAL. 

o27  Structure.     They  are  composed : 

1st,  of  a  Basement  Membrane  formed  of  connective  tissue. 

2d,  of  an  Epithelium  composed  of  tesselated  cells. 

Synovial  membranes  present  adipose  masses  and  vascular 
processes. 

The  Adipose  Masses,  at  one  time  erroneously  termed  the 
Haversian  glands, —  consist  simply  of  fat  cells  contained  in 
a  fold  or  projection  of  the  synovial  membrane. 

The  Vascular  Processes  present  an  analogous  structure, 
but  their  bulk  is  formed  of  a  great  number  of  capillaries 
which  give  them  their  red  coloration  and  cause  them  to  re- 
semble in  structure  the  choroid  plexuses  of  the  cavities  of 
the  brain. 

In  these  Synodal  Membranes  the  endothelium  and  base- 
ment membrane  stop  where  the  cartilage  begins. 

In  Other  Serous  Membranes  the  Visceral  Portion,  or  the 
portion  which  invests  the  organs,  consists  only  of  the  endo- 
thelium. 

Synovial  fluid  contains  lymph  corpuscles. 

CLASSIFICATION  OF  JOINTS. 

328  1.  Synarthrodial.  Sutures  (seams)  Dentated:  Tooth-like 
processes,  as  in  interparietal  sutures.  Serrated:  edges  like 
teeth  of  a  saw,  as  in  interfrontal  sutures.  Limbous:  bev- 
eled margins  and  dentated  processes,  as  in  the  fronto- 
parietal suture. 

Squamous  have  beveled  margins  overlapping  each  oilier, 
as  in  squamo-parietal. 

Harmonic:  opposition  of  contiguous  rough  surfaces,  as  in 
the  intermaxillary  suture. 

Schindylesis:  a  border  fitting  in  a  groove,  as  vomer  and 
sphenoid. 

Gomphosis:    teeth  in  their  sockets. 

2.  Diathrodial.     Fnarthrodial  or  Ball  and  Socket:  shoulder 
and  hip. 

Condyloid:    temporo-maxillary,  atlo-occipital. 
Mutual  Adaptation:  trapezo-phalangeal,  sterno-clavicnlar. 
Ginglymoid  or  Hinge-lih  :  elbow,  knee. 
Pivotal  or  Rotary:   odontoid,  radio-ulnar. 
Artkrodial:  facets  in  contact;  articular  processes  of  the 
vertebra?. 

3.  Amphiarthrodial :  with  partial  synovial  membrane  (sym- 
physis) without  synovial membram  (bodies  of  vertebra')- 


112  PECULIARITIES   OR   CHARACTERISTICS   OF   JOINTS. 

PECULIARITIES  OR  CHARACTERISTICS  OF  EACH  KIND 

OF  JOINT. 

329  Synarthrodia!  Joints  or  Immovable  Joints. 

Are  found  only  in  the  head. 
Articular  Surfaces:   Vary  according  to  location. 
Ligaments:  A  cartilaginous   substance   between  the   bones. 
Synovial  Membrane:  None. 
Movements:  None. 
Diarthrodial  or  Movable  Joints. 

JV.  B. — The  Articular  Surfaces  are  all  lined  with  cartilage. 
Enarthrodial  or  Ball  and  Socket  Joints. 

(Scapulo-humeral,  coxo-femoral. ) 
Articular  Surfaces:   On  one  of  the  bones,  a  socket  with  a 
nbro-cartilaginous  rim ;  a  head  on  the  other  bone. 
Ligaments:  A  capsular  ligament. 

It  always  presents  a  band  of  reinforcement  often  called  by 
a  special  name  (coraco-humeral,  ileo-femoral). 
Muscular  Ligaments:  The   joint   is  usually  surrounded  by 
short,  strong  muscles. 

Synovial  Membrane:   Is  usually  well  developed. 
Movements:   All  the  movements,  flexion,  extension,  abduc- 
tion, adduction,  circumflexion,  rotation  on  its  axis. 
Condyloid  Joints. 

(Temporo-maxillary  articulation. ) 
Articular   Surfaces:    An   elongated   head   on  one  bone  and 
a  similar  cavity  on  the  other. 

Inter-Articular  Fibro- Cartilage:   Sometimes  exists  (temporo- 
maxillary). 
Ligaments:  Always  capsular. 

Sometimes  presents  a  band  of  reinforcement. 
Synovial  Membrane:  Is  well  developed. 

It  is  sometimes  divided  into  two  by  the  cartilage. 
Movements:  All  except  the  rotation  on  axis. 
Mutual  Adaptation  Joints. 

(Sterno -clavicular,  trapezo-phalangeal. ) 
Articular  Surfaces:  They  are  concave  in  one  direction  and 
convex  in  the  other,  and  are  so  opposed  to  each  other  as  to 
adapt  themselves  to  each  other. 

Inter -Articular  Fibro- Cartilage:  Is  sometimes  found  (as  in 
the  sterno -clavicular). 
Ligaments:  A  capsular  ligament  mainly. 
Synovial  Membrane:  Is  well  marked. 
Movements:  All  except  rotation  on  axis. 
Ginglymoid  or  Hinge=like  Joints.     (Elbow,  knee.) 
Articular   Surfaces:     On    one    bone,  two  prominences ;   on 
the  other,  two  cavities. 

Inter-articular  Fibro- Cartilage:   Exists  in  some. 
Ligaments:  Lateral  ligaments,  which  are   the  strongest  in 


ARTICULATIONS  OF  THE  BONES  OF  THE  VERTEX  OF  BKULL.      1  L3 

some   situations,  an  anterior  and   a   posterior   more  or  Less 

evident  and  strong. 

Synovial  Membrane:   Is  usually  extensive. 

Movements:   Only  flexion  and  extension. 

Pivotal  or  Rotary  Joints.     (Odontoid,  radio-ulnar. ) 

Articular  Surfaces:    A  head  with  a  sharp  neck  on  one  bone, 

and  a  partial  cavity  on  the  other. 

Ligaments:   Usually    a   strong-   band,    the    lower  border  of 

which  is  shorter  than  the  upper  so  as  to  strangle  the  head 

as  it  were. 

Muscular    Ligaments:    Usually    a  group    of    short,    round 

muscles  surround  the  joint. 

Synovial  Membrane:   Is  usually  small. 

Movements:   Those  of  rotation  of  one-quarter  of  a  circle. 

Arthrodial  Joints.     (Articular  processes  of  vertebra?.) 
Articular  Surfaces:    Usually   small  facets,   plane,    or  con- 
cave, or  conyex. 

Ligaments:  A  short,  limited  capsule. 
Synovial  Membrane:  Is  very  limited. 
Movements:    A  mere  gliding  motion. 

Amphiarthrodial  Joints  or  Partly  flovable  Joints. 

1st  Variety:  Amphiarthrodial  Joints  With  Synovial 
Membrane  (pubis,  sacro-iliac). 

Articular  Surfaces:  A  small  part  only  of  the  bones  in  con- 
tact is  lined  with  cartilage ;  the  larger  part  is  rough  for  lig- 
amentous attachments. 

Ligaments:  The  most  important  is  always  a  strong  inter- 
osseous ligament  —  presents  also  more  or  less   important 
peripheral  ligaments. 
Synovial  Membrane :   Is  more  limited. 
Movements:   Are  very  limited. 

2d  Variety:    Amphiarthrodial  Joints   Without  Synovial 

Membrane  such  as  between  the  intervertebral  discs. 

Articular  Surfaces:   Are  all  rough. 

Ligaments:   Are  strong  bands  of  fibro- cartilaginous  tissue. 
Synovial  Membrane:   Is  absent ;   however,  the  centre  of  the 
ligament  presents  a  spot  softer  than  the  balance. 
Movements:   Are  still  more  limited  than  in  the  other  variety. 


ARTICULATIONS  OF  THE  BONES  OF  THE  VERTEX  OF 

THE  SKULL. 

330       They  are  all  synarthrodia  Is. 

They  are  all  serrated  or  dentated. 


114  RESUME  OF  THE  IMPORTANT  JOINTS. 

ARTICULATIONS    OF    THE    BONES    OF   THE    SIDES    OF 

THE    SKULL. 

They  are  in  the  temporal  fossa. 
They  are  all  synarthrodials. 
They  are  all  squamous. 

ARTICULATIONS  OF  THE  BONES  AT  THE  BASE  OF 

THE  SKULL. 

They  are  all  synarthrodials. 
They  are  all  harmonic  sutures. 

ARTICULATIONS  OF  THE  BONES  OF  THE  FACE. 

They  are  synarthrodials 
They  are  all  harmonic  sutures. 

ARTICULATIONS  OF  THE  BONES  OF  THE  UPPER  JAW 
WITH  THE  BONES  OF  THE  HEAD. 

They  are  all  synarthrodial. 
They  are  slightly  serrated. 


RESUME  OF  THE  iriPORTANT  JOINTS. 

ARTICULATION     OF     THE     LOWER     JAW    WITH    THE 

BONES    OF    THE    HEAD    OR    TEMPORO- 

MAXILLARY  ARTICULATION. 

331  The  Temporo=Maxillary. 

Class :   Condyloid. 

Articular  Surfaces:  Glenoid  Cavity  of  temporal  bone,  Con- 
dyle of  Inferior  Maxillary, —  Inter-articular  fibro-cartilage. 
Ligaments:  Capsular,  External  Lateral, —  Internal  Lateral 
or  spheno-maxillary  (origin,  spinous  process  of  sphenoid; 
insertion,  inner  surface  of  ascending  branch  of  inferior 
maxillary)  ; — Posterior  Ligament  or  Stylo -maxillary  (origin, 
styloid  process  ;  insertion,  angle  of  jaw)  ; — Pterygo-maxillary 
Ligament  (origin,  pterygoid  process;  insertion,  inner  sur- 
face of  ascending  branch  of  maxillary). 

Synovial  Membrane:  Is  double,  one  above  and  one  below 
the  cartilage. 

Movements:  Flexion,  extension,  abduction,  adduction, i.  e., 
all  except  rotation  on  axis. 


ARTICULATIONS  OF  OCCIPITAL,   YKKTKI'.k.i:  AND  RIBS.  1  1  5 

ARTICULATIONS  OF  OCCIPITAL  WITH  ATLAS  AND 

AXIS. 

332  These  bones  arc  joined  by  their  bodies,  their  Laminae,  their 
articular  surfaces. 

The   most   interesting-  of  all  these  are  the  articulations  of 
the  odontoid  process  with  the  atlas  and  the  occipital. 

They  are  : 
Class:   Pivotal. 

Ligaments:  All  the  most  interesting  Ligaments  arc  in  the 
interior  of  the  spinal  canal. 

1,   Superficial  occipito-axoid  ; — 2,  middle   occipito-axoid ; 

—  3,  deep  occipito-trausverse ;  —  4,  transverse  ligament 
(Origin  and  Insertion,   inner  surface  of  occipital  foramen)  ; 

—  5,  axoido-transverse  (completes   the  crucial    ligament); 

—  6,  occipito-odontoid ;  7,  odonto-atloid  (Insertion,  to  tu- 
bercle on  inner  surface  of  atlas). 

ARTICULATIONS  OF  THE  VERTEBRAE. 

333  The    Vertebra?    articulate  by   their  bodies,  their  lamina?; 
their  articular  processes  are  their  spinous  processes. 
Ligaments  :  The  most  important  ligaments  are 

1st.  Anterior  Vertebral,  a  strong  fibrous  band  extending 
all  along  the  anterior  surface  of  the  bodies  of  the  verte- 
bra?. 

2d.  The  Intervertebral  Discs,  situated  between  the  bodies 
and  composed  of  strong  fibro -cartilaginous  fibres  arranged 
in  a  semi-circular  ring. —  They  are  unique. 
3d.  The  Posterior  Vertebral  Ligament,  situated  in  the  in- 
terior of  the  vertebral  canal,  is  a  fibrous  band  extending  ;ill 
along  the  posterior  surface  of  the  bodies. 
4th.  The  Yellow  Elastic  Ligaments  joining  the  laminae — 
they  are  thick  and  strong  and  thoroughly  elastic. — They  are 
unique. 

5th.  The  Capsular  Ligaments  around  the  articular  pro- 
cesses. 

6th.  The  Supra=5pinous  Ligaments  joining  the  spinous 
processes. 

ARTICULATIONS  OF  THE  RIBS. 

334  The  articulations  of  the  Ribs  are  all  Amphiarthrodials. 
The  Heads  of  the  Ribs  articulate   with  the  bodies  of  the 
vertebra?. 

The  Ligaments  are  an  interosseous  ligament  extending 
from  the  ridge  on  the  head  to  the  intervertebral  disc. — 
by  an  anterior  fan-shape  ligament. 

The  Tuberosities  of  the  Ribs  articulate  with  the  apes  ><( 
the  transverse  processes. 


116  ARTICULATION  OF  SACRUM  AND  COCCYX,  ULNA  AND  RADIUS. 

The  Ligaments  are  —  an  interosseous  ligament  situated 
between  the  neck  of  the  rib  and  the  transverse  process  — 
a  superior  or  castro-transverse  ligament, —  a  posterior  liga- 
ment. 

The  Anterior   Extremity   of  the  Ribs  articulate  with  the 
chondral  cartilages  and  are  synarthrodial. 
The  Chondral  Cartilages  articulate  with  the  sternum  and 
are  also  synarthrodial. 

ARTICULATION  OF  THE  SACRUM  AND  COCCYX. 

Is  an  arthrodial  articulation. 
The   Ligaments    are     an    anterior,  a   posterior    and   two 
laterals. 

STERNO-CLAVICULAR  ARTICULATION. 

335  Class  :  Mutual  adaptation. 

Articular  Surface :  Facets  on  Clavicle,  facets  on  Sternum; 
Inter  articular  Cartilage . 

Ligaments  :  Anterior,  Posterior,  Superior  or  Interclavicular . 
Movements  :  All  except  rotation  on  axis. 

SCAPULO-HUMERAL. 

336  Class:  Enarthrodial,  or  ball  and  socket. 

Articular  Surfaces:    Glenoid  Cavity  of  scapula  deepened  by 

a  fibro-cartilaginous   ring    around   the   margin; — Head  of 

Humerus. 

Ligaments  :   Capsular  ligament  and  Cor aco -humeral — Long 

head    of  biceps  ; —  supra-spinous,  —  infra-spinous,  —  small 

round  and  subscapular  muscles. 

Synovial  Membrane  is  very  extensive. 

Movements  :  All :  flexion,  extension,  abduction,  adduction, 

circumduction  and  rotation  on  its  axis. 

THE  ELBOW  JOINT. 

337  Divisions.  It  comprises  the  articulation  of  the  humerus 
with  the  radius  and  ulna,  and  the  articulation  of  the  upper 
extremity  of  the  radius  with  the  ulna. 

ARTICULATION  OE  HUMERUS  WITH  ULNA  AND 
RADIUS. 

Class:  Ginglymoid  or  hinge-like. 

Articular  Surfaces:  Humerus:  the  trochlea  and  the  small 
head  of  the  humerus. —  Ulna:  great  sigmoid  notch  formed 
by  the  olecranon  process  and  coronoid  process. —  Radius: 
concave  facet  at  upper  extremity. 


ULNO-RADIAL,  RADIO-CARPAL  ARTICULATION.  11  i 

Ligaments :  Anterior  and  Posterior,  weak  ; —  Internal  Lat- 
eral (Origin,  internal  condyle;  Insertion,  two  heads  into 
olecranon  process  and  coronoid  process);  External  Ij<iI<  ml 
ligament  (Origin,  external  condyle  ;  Insertion,  ligament  of 
the  radio-ulnar  articulation). 

Synovial  Membrane:   is  extensive;  sends  a  process  under 
the  triceps. 
Movements:   Flexion  and  extension. 

UPPER  ULNO-RADIAL  ARTICULATION. 

338  Class:  Pivotal. 

Articular  Surfaces.  Ulna:  lesser  sigmoid  notch. —  h'<i<Hns: 
ring  supporting  the  facet  of  the  head. 

Ligaments:  Semi-circular  ligament  (Origin,  in  front  of 
lesser  sigmoid  cavity;  Insertion,  behind  it). —  The  upper 
border  receives  the  fibres  of  the  anterior  and  lateral  liga- 
ments of  elbow, — the  lowTer  border  is  tightly  drawn  around 
the  head  and  grasps  it  as  it  were. 

Synovial  Membrane:  it  always  communicates  with  the  elbow 
joint. 
Movements:   Pronation  and  supination. 

LOWER  ULNO-RADIAL  ARTICULATION. 

339  Class:  Pivotal. 

Articular  Surfaces:  A  small  convex  facet  on  the  head  of 
the  ulna  —  a  small  concave  facet  on  the  radius. 
Ligaments  are:  Anterior  strong — posterior  strong  also — 
a  peculiar  triangular  fibro-elastic  ligament  or  cartilage  extend- 
ing from  the  radius  to  the  groove  between  the  head  of  the 
ulna  and  the  styloid  processes. 

Synovial   Membrane  :   It  does  not  communicate   with  that 
of  the  wrist. 
Movements  :   Rotation  of  one-quarter  of  a  circle. 

WRIST  JOINT. 

340  Division:  Comprises  the  articulations  between  the  bones 
of  the  forearm  themselves  and  with  the  bones  of  tin-  first 
row  of  the  carpus,  also  the  articulations  between  the  two 
rows. 

1st.  RADIO-CARPAL  ARTICULATION. 

Class:   Condyloid. 

Articular  Surfaces.     Forearm:   lower  extremity  of  radius, 

triangular   fibro-cartilage.—  Car}*"*:    scaphoid,    semilunar, 

and  pyramidal  or  cuneiform. 

Ligaments:  Anterior  ligament,  strong: — External  Lateral, 

strong  (Origin,  styloid  process  of  radius:   Insertion,   sea- 


118         INTERCARPAL,  SACROILIAC,  FEMORAL  ARTICULATION. 

phoid)  ; — Internal  Lateral  ligament,  strong  (Origin,  styloid 
process  of  ulna;  Insertion,  pyramidal  and  pisiform). 

Synovial  Membrane;  It  communicates  with  all  the  articu- 
lations of  the  wrist. 

Movements  :  Flexion,  extension,  abduction,  adduction,  cir- 
cumduction. 

2d.  INTERCARPAL  ARTICULATIONS. 

341  Class:   Condyloid. 

Articular  Surfaces.  Upper  Row:  cavity  formed  by  sca- 
phoid, semilunar  and  pyramidal. —  Lower  Row:  head  formed 
by  great  bone  (os  magnum). 

Ligaments:  Anterior,  strong;  Posterior,  weak; — External 
Lateral  (Origin,  scaphoid;  Insertion,  trapezium)  ; — Internal 
Lateral  ligaments  (Origin,  pyramidal  and  pisiform ;  In- 
sertion, cuneiform  and  fifth  metacarpal). 

Synovial  Membrane  communicates  with  all  the  others. 
Movements  :  Same  as  radio-carpal,  but  more  limited. 

THE  SACRO-ILIAC  ARTICULATION. 

342  Class :  Amphiarthrodial. 

Articular    Surfaces.     Sacrum:     auricular    facet. —  Ilium: 

same. 

Ligaments:    Interosseous,  very  strong; — Anterior,  weak; — 

Large  and  Small  Sacro-sciatic; — Posterior,  strong ; — Superior, 

strong ; — Inferior,  strong. 

Movements:   Very  limited. 

THE  SYMPHYSIS  PUBIS  ARTICULATION. 

343  Class :  Amphiarthrodial. 

Articular  Surfaces:  A  small  facet  lined  with  cartilage  oc- 
cupying the  posterior  part  of  the  articular  surfaces  —  in 
front  of  this  a  larger  rough  surface.. 

Ligaments:  an  interosseous  strong  —  an  anterior   strong 
also  —  a  posterior  weak  —  a  superior  strong  —  an  inferior 
arch- like  ligament,  strong. 
Synovial  Membrane  :  Is  limited. 

Movements :  They  are  limited,  but  in  pregnancy  they  in- 
crease, as  also  in  the  sacro-iliac articulation. 

THE  COXO-FEMORAL. 

344  Class  :  Enarthrodial  or  ball  and  socket. 

Articular  Surfaces.  Innominate  Bone:  acetabulum — deep- 
ened by  fibro -cartilaginous  ring, — presenting  a  back  cavity 
not  lined  with  articular  cartilage. — Femur:  the  head  pre- 
senting a  pit  deprived  of  cartilage. 


KNEE  JOINT  OK  TIBIO-FEMOKAL  ARTK  TLATK  >N.  1  1!) 

Ligaments:  Capsular  (Origin,  margin  of  acetabulum;  In- 
sertion in  front  to  the  anterior  intra-trochanteric  Line;  be- 
hind, it  grasps  the  neck  below  the  head  like  the  radio-ulnar 
ligament); — Ilio-femoral  (Origin,  anterior  inferior  spinous 
process;  Insertion,  small  trochanter); — Round  ligament 
(Origin,  margin  of  back  of  cavity  of  acetabulum  ;  [nserl  ion. 
pit  in  head  of  femur) . 

Synovial  Membrane  sometimes  communicates  with  the  se- 
rous bursa  and  the  psoas-iliac. 

Movements:  Flexion,  extension,  abduction,  adduction,  cir- 
cumduction and  rotation. 

KNEE  JOINT  OK  TIBIO-FEMORAL. 

345  Class  :  Ginglymoid  or  hinge-like. 

Articular  Surfaces.  Femur:  the  two  condyles  united  in 
front  but  separated  behind. — Tibia:  the  two  glenoid  cavi- 
ties separated  by  the  spine  of  the  tibia. — Patella:  articular 
facets  occupying  the  upper  two-thirds  of  its  posterior  sur- 
f a ce .  — Semilunar  Fibro-ca rtilages . 

Ligaments:  Anterior  or  Patellar,  very  strong  (Origin,  pa- 
tella ;  Insertion,  anterior  tuberosity  of  tibia)  ; — Posterior  lig- 
ament, or  ligament  of  Winslow,  strong  (Origin  and  Inser- 
tion, outer  condyle  of  femur  to  inner  tuberosity  of  tibia, 
and  margin  of  condyles  and  tuberosities)  ; — External  liga- 
ment, strong  and  cord-like  (Origin,  outer  condyle;  Inser- 
tion, styloid  process  of  fibula) ; — Interosseous  or  Crucial  liga- 
ments (Origin,  inner  surface  of  condyles;  Insertion,  in  front 
and  behind  spine  of  tibia)  ; — Adipose  ligaments  (Origin, 
patella;  Insertion,  spine  of  tibia); — Internal  and  External 
Patellar  ligaments  (capsular)  (Origin,  border  of  patella  ; 
Insertion,  tuberosities  of  tibia). 

Synovial  Membrane  is  very  extensive, —  it  sends  a  large 
process   under   the  biceps — and  also  small  ones  under  the 
patellar  ligament. 
flovements  :  Flexion  and  extension. 

UPPER  TIBIO -PERONEAL  ARTICULATION. 

346  Class :  Arthrodial. 

Articular  Surfaces:  Each  bone  presents  a  round  facet. 

Ligaments:    They  are:   an  auterior,  strong;  a  posterior, 

strong. 

Synovial  Membrane :  Sometimes  communicates  with  that 

of  the  knee. 

riovements  :  A  gliding  motion. 

LOWER  TIBIO-PERONEAL  ARTICULATION. 

Class :  Amphiarthrodial. 

Articular  Surfaces  :  Each  bone  presents  a  small  facet  ami  a 

more  extensive  rough  surface. 


120  ANKLE  JOINT,  TARSUS  ARTICULATIONS. 

Ligaments :  They  are  anterior  strong  and  a  posterior  also 

strong. 

Synovial  Membrane :  It  also  communicates  with  that  of 

the  ankle  joint. 

ANKLE  JOINT  OR   TIBIO-TARSAL. 

347  Class :  Ginglymoid. 

Articular  Surfaces.  Leg:  lower  extremity  of  tibia;  inter- 
nal malleolus ;  external  malleolus. — Foot:  three  facets  on 
astragalus. 

Ligaments  :  Anterior  and  Posterior,  weak ; — External  Lat- 
eral, strong  (Origin,  apex  of  malleolus ;  Insertion,  astrag- 
alus in  front  and  behind,  calcaneum  in  middle)  ; — Internal 
Lateral,  ligament,  strong  (Origin,  internal  malleolus;  In- 
sertion, astragalus  and  calcaneum). 

Synovial  Membrane   is  extensive  —  it  communicates  with 
that  of  the  lower  tibio-peroneal  articulation. 
flovements  :  Flexion  and  extension. 

ARTICULATIONS  OF  THE   TARSUS. 

348  1st.  Articulation  of  Astragalus  and  Calcaneum. 
Class :  Arthrodial. 

Articular  Surfaces:  Two  facets  on  each  bone. 

Ligaments :  Interosseous,  strong  (in  grooves  between  the 

facets)  ;  — Capsular,  weak  (around  the  facets). 

Synovial  Membrane:  It  communicates  with  that  of  all  the 

articulations  of  the  tarsus. 

Movements :   Gliding  motion. 

ARTICULATION    BETWEEN   THE    FIRST    AND    SECOND 

ROWS. 

349  Class :  Arthrodial. 

Articular  Surfaces :  Facet  on  head  of  Astragalus  articu- 
lating with  scaphoid; — facet  on  Calcaneum  articulating  with 
cuboid. 
Ligaments : 

Dorsal  Ligaments:  Dorsal  calcaneo-cuboid ;  interosseous 
or  Y  ligament  (from  calcaneum  to  cuboid  and  scaphoid) ; 
astragalo-scaphoid. 

Internal  Ligament:  Calcaneo-scaphoid,  bridging  over  head 
of  astragalus ;  very  strong. 

Plantar  Ligaments:    Long    plantar   or   calcaneo-cuboid; 
short  plantar  or  calcaneo-cuboid. 
Movements :  Gliding  motion. 

350  Articulations  of  the  iletatarsal :  Are  the  same  as  those 
of  the  hands. 

The  great  toe  has  no  separate  articulation. 


RESUME   OP   MUSCLES.  121 

riUSCLES. 

RESUME  OF  STRUCTURE  OF  THE  MUSCULAR  TISSUE. 

There  are  two  sorts  of  Muscular  Fibres,  the  smooth  mus- 
cular and  the  striped  muscular  fibres. 

351  Striped  fluscular  Fibres  are  composed — 1st,  of  an  Envel- 
ope called  the  Myolemma  ; — 2d,  of  a,  Proper  Substanci  com- 
posed of  muscular  fibrils  —  composed  themselves  of  minute 
particles  called  the  Sarcous  Elements) — 3d,  of  Capillaries 
which  run  parallel  with  the  muscular  fibres. 

Smooth  Muscular  Fibres  are  composed  of  fusiform  nu- 
cleated cells,  which  unite  together  to  form  muscular  fasci- 
cules or  bundles. 

RESUME  OF  THE  STRUCTURE  OF  TENDONS. 

352  Tendons  are  composed  of  an  Envelope, —  of  bundles  of 
dense  connective  tissue, — of  elastic  fibres, —  of  connective  tissue 
corpuscles. 

APONEUROSES  OR  FASCLE. 

353  Structure.  They  are  formed  of  fine  bundles  of  connective 
tissue. 


RESUHE  OF  MUSCLES  (ORIGIN,   INSERTION  AND 
ACTION). 

MUSCLES  OF  THE  HEAD. 

CRANIAL  REGION. 

354  Occipito=frontal :    Origin,  superior  curved  line  of  occipital : 
Insertion,  skin  over  eyebrow. 

AURICULAR    REGION. 

Anterior  Auricular  :   Origin,  zygoma;   Insertion,  helix. 

Posterior   Auricular:    Origin,  mastoid  process:   Insertion, 

concha. 

Superior   Auricular:    Origin,    temporal  fascia;    Insertion, 

concha. 

PALPEBRAL   REGK  >X . 

Palpebral  Orbicular:  Origin,  direct  tendon,  from  nasal 
process  of  superior  maxilla:  reflected  tendon,  from  crest 
of  lachrymal  bone;  Insertion,  skin  of  outer  region  of  eyelid. 
Tensor  of  the  Tarsal  Cartilages:  Origin,  membrane  of 
lachrymal  sac;   Insertion,  lachrymal  points. 


122  MUSCLES   OF  THE   HEAD. 

Superciliary  or  Contractor  of  the  Eyebrows:  Origin, 
superciliary  ridge ;  Insertion,  skin  of  the  eyebrow. 

NASAL    EEGION. 

355  Pyramidal :  Origin,  nasal  bone ;  Insertion,  skin  between 
the  eyebrows. 

Common    Elevator  of  Wing   of    Nose    and   Upper    Lip : 

Origin,  nasal  process ;  Insertion,  wing  of  nose  and  skin  of 

upper  lip. 

Dilator  of  the  Nostrils  :  Origin,  median  cartilage  of  nose ; 

Insertion,  wing  of  nostrils. 

Compressor  of  Nostrils  :   Origin,  incisive  fossa  of  superior 

maxilla;    Insertion,  skin  of  septum  and  wings  of  nostrils, 

BUCCAL  OR  ORAL  REGION. 

356  1st.  Orbicular  Muscle :   Origin  and  Insertion,  skin. 

2d.  Elevators  of  Upper  Lip,  Common  Elevator  (see 
above),  Proper  Elevator :  Origin,  margin  of  orbit;  Inser- 
tion, skin  of  lip. 

3d.   Elevator   of  the  Commissures:    Small    Zygomatic: 
Origin,  malar  bone;    Insertion,  skin  of  lip. 
Great  Zygomatic :   Origin,  malar  bone  and  zygoma ;   Inser- 
tion, skin  of  lip. 

4th.   Proper  Elevator  of  Commissure  or  Canine  Muscle: 
Origin,  canine  fossa;  Insertion,  skin  of  lip. 
5th.   Retractors  of  the  Commissures:    Risorius:    Origin, 
formed  by  the  highest  fibres  of   the  platysma ;    Insertion, 
skin  of  lip. 

Buccinator :  Origin,  pterygo-maxillary  ligament,  alveolar 
processes  of  the  two  maxillae ;  Insertion,  skin  of  angle  of 
mouth. 

6th.  Depressor  of  the  Commissure  :  Triangular  Muscle: 
Origin,  oblique  line  of  inferior  maxilla;  Insertion,  skin  of 
angle. 

7th.  Depressor  of  the  Lower  Lip :  Square  Muscle  of 
Chin:  Origin,  base  of  inferior  maxilla;  Insertion,  skin  of 
lip. 

8th.  Elevator  of  the  Lower  Lip :  Origin,  symphysis  of 
maxilla;   Insertion,  skin  of  lip. 

TEMPORO-MAXILLARY  REGION. 

357  Masseter :  Origin,  zygoma  and  malar  bone;  Insertion, 
outer  surface  of  vertical  branch  of  lower  maxilla.  Action, 
elevates  lower  jaw. 

Temporal:  Origin,  temporal  fossa;  Insertion,  coronoid 
process  of  inferior  maxilla.     Action,  same. 

PTERYGO-MAXILLARY   REGION. 

External  Pterygoid  :  Origin,  inferior  surface  of  wing  of 
sphenoid  and  external  surface  of  pterygoid  process  ;    Inser- 


MUSCLES  OP  NECK.  L23 

Hon,  depression  in  neck  of  condyle.  Ad  ion,  causes  the 
grinding"  motion  of  the  jaw. 

Internal  Pterygoid:  Origin,  pterygoid  fossa:  Insertion,  in- 
ner surf  ace  of  vertical  branch  of  inferior  maxilla.     Action, 

same. 

MUSCLES  OF   NECK. 

SUPERFICIAL    REGION. 

358  1st.  Platysma  :   Origin,  oblique  line  of  inferior  maxilla  and 

skin  of  angle;  Insertion,  skin  over  the  clavicle.  Action, 
stretches  the  skin  of  the  neck. 

Sterno=cleido  Mastoid  :  Origin,  sternum  and  internal  ex- 
tremity of  clavicle;  Insertion,  mastoid  process.  Action, 
rotates  the  face  to  the  opposite  side ;  when  both  act  they 
extend  the  head. 

SUPRA-HYOID  REGION. 

359  Digastric:  Origin,  digastric  groove  of  occipital:  Insertion, 
inner  surface  of  inferior  maxilla.  It  pierces  the  tendon  of 
the  stylo-hyoid  where  this  is  attached  to  the  hyoid  bone. 
Action,  raises  the  larynx. 

Stylo=hyoid  :  the  name  indicates  origin  and  insertion. 
Mylo=hyoid  :    Origin,  internal  obliqne  line  of  inferior  max- 
illa ;    Insertion,  hyoid  bone.     Action,  raises  the  larynx. 
Geni<>=nyoid  :    Origin,  inferior  genial  tubercle  of   inferior 
maxilla;  Insertion,  hyoid  bone.     Action,  raises  the  larynx. 

INFRA -HYOID  REGION. 

Sternohyoid,  Sternothyroid,  Thyrohyoid,  Omo=hyoid  ; 

The  names  indicate  origin  and  insertion.  They  are  de- 
pressors of  the  larynx  and  jaw. 

ANTERIOR  VERTEBRAL  REGION. 

360  Large  Anterior  Strait:  Origin,  tubercles  of  transverse 
processes  of  the  four  upper  cervical  vertebrae;  Insertion,  bas- 
ilar process  of  occipital  bone. 

Small   Anterior   Strait:     Origin,  transverse  process  of  at- 
las ;    Insertion,  basilar  process  of  occipital. 
Lateral    Strait:     Origin,   transverse    process  of  atlas;   In- 
sertion, jugular  process  of  occipital. 

Long  Cervical  Muscle  —  Inner  Portion  :  Origin,  bodies  of 
upper  cervical  vertebrae ;  Insertion,  bodies  <>f  upper  dorsal 
vertebra?.  Action,  all  act  as  active  ligaments. 
Lower  Portion:  Origin,  bodies  of  dorsal  vertebrae;  Inser- 
tion, transverse  processes  of  fifth  and  sixth  cervical  vertebrae. 
Upper  Portion:  Origin,  transverse  processes  of  upper  cer- 
vical vertebrae:  Insertion,  tubercle  on  anterior  surf  ace  of 
atlas. 


124  MUSCLES  OF  BACK. 


LATERAL  VERTEBRAL  REGION. 

361  Anterior  Scalene:   Origin,  anterior  tubercles  of  four  upper 
cervical  vertebras ;  Insertion,  tubercle  on  first  rib. 
Middle    Scalene:   Origin,   posterior    tubercles  of  cervical 
vertebras;  Insertion,  first  rib ,  behind  groove  for  subclavian 
artery. 

Posterior  Scalene:  Origin,  posterior  tubercles  of  cervical 
vertebras  ;  Insertion,  second  rib. 

MUSCLES  OF  BACK. 

FIRST   LAYER. 

362  Trapezius :  Origin,  superior  curved  line  of  occipital 
nuchal  ligament,  spinous  processes  of  dorsal  vertebras ;  In- 
sertion, spine  of  scapula ;  posterior  convexity  of  clavicle. 
Action,  raises  the  shoulder  by  its  upper  fibres  and  depresses 
it  by  its  lower  fibres ;  when  both  muscles  act,  the  shoulders 
are  drawn  towards  the  spine.  The  upper  fibres  rotate  the 
head  to  the  opposite  side;  the  two  sides  acting  simulta- 
neously extend  the  head. 

Great  Dorsal :  Origin,  crest  of  ilium,  spinous  processes  of 
sacrum  and  lumbar  vertebras,  lower  ribs ;  Insertion,  bicipi- 
tal groove  of  the  humerus.     Action,  adducts  the  arm. 

SECOND  LAYER. 

Elevator    of    Scapula:     Origin,    transverse    processes  of 

three  upper  cervical  vertebras ;  Insertion,  upper  part  of  spinal 

border  of  scapula. 

Rhomboid  :   Origin,  spinous  processes  of  lower  cervical  and 

upper   dorsal   vertebras ;    Insertion,    lower  portion   of   the 

spinal   border   of    the    scapula.     Action,  raises   the   lower 

angle  of  the  scapula. 

Inferior  Serrate :    Origin,  spinous  process  of  lower  dorsal 

and  upper  lumbar  vertebras;  Insertion,  lower  ribs  (body). 

Action,  depresses  the  lower  ribs. 

THIRD   LAYER. 

Splenious  (spinous  occipito-transverse)  :  Origin,  spinous 
processes  of  six  upper  dorsal  and  two  lower  cervical; 
Insertion,  transverse  processes  of  three  upper  cervical 
and  outer  portion  of  rough  space  of  occipital  bone.  Action, 
rotates  the  head  to  the  same  side. 

Superior  Serrate  :  Origin,  spinous  process  of  last  two  cer- 
vical and  upper  two  dorsal  vertebras ;  Insertion,  body  of 
upper  ribs.     Action,  raises  the  upper  ribs. 

FOURTH  LAYER. 

363  Complexus  (or  transverso-occipito-mastoid) :  Origin, 
transverse  processes  of  five  upper  dorsal  and  four  lower 


MUSCLES   OF   HACK.  125 

cervical;  Insertion,  inner  half  of  rough  surface  of  occipital 

bone,  a  portion  being  attached  to  the  mastoid  process  (les- 
ser complexus  or  trachelo-mastoid) . 

Cervical  Digastric  (biventer  cervicis)  is  the  inner  por- 
tion of  the  complexus,  which  presents  a  tendinous  portion 
in  its  middle  part.  Action,  extends  the  head  and  rotates  it 
to  the  same  side. 

Spinal  Erector:  1st,  Common  Mass:  Origin,  sacro-iliac 
gutter;  Insertion,  divides  into  sacro-lumbal  and  long  dorsal ; 
2d,  Sacrolumbal  (or  ilio-costal) ;  Ascending  portion: 
Origin,  crest  of  ilium;  Insertion,  ribs  near  angle;  Ac- 
cessor)/ or  Descending  portion  (same  insertion)  ;  Ascend- 
ing cervical  (or  costo-transverse)  ;  Origin,  angle  of  four  upper 
ribs;  Insertion,  transverse  processes  (posterior  tubercles)  of 
three  lower  cervical  vertebra? ;  3d,  Long  Dorsal  (or  sacro- 
transverso-costal);  1st,  is  prolonged  into  the  neck  as  the 
Transverse  Cervical:  Origin,  transverse  processes  of  six 
upper  dorsal  vertebra?;  Insertion,  transverse  processes  of 
six  lower  cervical  vertebra?;  2d,  Dorsal  Spinous:  Origin. 
spinous  processes  of  the  two  upper  lumbar  and  two  lower 
dorsal ;  Insertion,  eight  upper  dorsal  spinous  processes;  3d, 
Semi-spinal  of  Back  {under  the  dorsal  spinous)  is  prolonged 
into  the  neck  (which  is  under  the  complexus);  Origin. 
transverse  processes  of  lower  dorsal  vertebra?:  Insertion, 
spinous  processes  of  upper  dorsal  vertebra?;  4th,  Semi- 
spinal of  Neck  is  under  the  complexus;  Origin,  transverse 
processes  of  the  four  upper  dorsal  vertebra*  and  articular 
processes  of  the  lower  four  cervical  vertebra- ;  Insertion, 
spinous  processes  of  four  upper  cervical  vertebra?. 

FIFTH    LAYER. 

364  Multifid  or  Transverse  Spinal  or  Rotator  Muscle  of 
Spine.  Origin,  transverse  processes;  Insertion,  spinous 
processes. 

Large  Posterior  Straight:  Origin,  spinous  processes  of 
axis;  Insertion,  lower  rough  surface  of  the  occipital:  Ac- 
tion, is  an  active  ligament. 

Small  Posterior  Straight:  Origin,  spinous  process  of 
atlas;  Insertion,  same  but  inner  portion  :  Action,  the  same. 
Inferior  or  Great  Oblique  or  Atlo=axoid  :  Origin,  spinous 
processes  of  axis;  Insertion,  transverse  process  of  atlas. 
Action,  rotates  the  head. 

Superior  or  Small  Oblique  or  Atlo=occipital :  Origin. 
transverse  process  of  atlas;  Insertion,  occipital  bone  behind: 
Action,  the  same. 

Interspinal  (in  neck  only) :  between  the  spinotis  process  - 
Intertransverse    Huscles   between    transverse    proci 
are  active  ligaments. 
Extensor  of  Coccyx:   Origin,  sacrum;   Insertion,  coccyx. 


126  MUSCULAR  LAYERS   OF  NECK — MUSCLES   OF   CHEST. 

MUSCULAR  LAYERS  OF  NECK. 

365  (Posterior  Cervical  Region.) 

FIRST   LAYER. 

Trapezius. 

SECOND  LAYER. 

Elevator  of  Scapula  ;  Splenius. 

THIRD    LAYER. 

1st,  Complexus  (comp rising1  trachelo-mastoid  and  cervical 
digastric) ;  2d,  Transverse  Cervical ;  3d,  Ascending 
Cervical. 

FOURTH   LAYER. 

1st,  Cervical  Spinous;  2d,  Posterior  Straight  and 
Oblique  ITuscles. 

FIFTH   LAYER. 

1st,  Semi=spinal  of  neck  or  cervical  portion  of  multifid 
muscle ;  2d,  Supra=spinous  (in  neck  only) ;  3d,  Inter- 
spinous ;  4th,   Intertransverse  muscles. 

MUSCLES  OF  THE  CHEST. 

366  Great  Pectoral  Muscle:  Origin,  sternum,  middle  ribs; 
anterior  convexity  of  clavicle  ;  Insertion,  bicipital  groove  of 
the  humerus  (outer  edge)  ;  Action,  adducts  the  arm. 
Small  Pectoral :  Origin,  external  surface  of  the  third, 
fourth  and  fifth  ribs;  Insertion,  coracoid  process;  Action, 
depresses  the  outer  angle  of  the  scapula,  and  raises  the 
upper  ribs. 

Subclavian  fluscle  :  Origin,  under  surface  of  the  clavicle ; 
Insertion,  first  rib. 

Great  Serrate    Muscle :    Origin,    external  surface   of  the 
upper  eight  ribs;  Insertion,  spinal  border  of  the  scapula. 
Action,  draws  the  scapula  forwards  or  raises  the  ribs. 
Intercostals  :  Origin,  the  border  of  the  rib  above ;  Insertion, 
the  border  of  the  rib  below. 

N.  B. — The  External  Intercostals  start  from  the  trans- 
verse processes  of  the  vertebra?  and  do  not  reach  the  an- 
terior extremities  of  the  ribs.  The  Internal  Intercostals 
start  from  the  angle  of  the  ribs  and  reach  the  sternum. 
Action,  when  the  first  rib  is  fixed  they  are  inspirators ;  when 
the  last  rib  is  fixed  they  are  expirators. 
Supra=costals :  Origin,  apex  of  transverse  processes  of  ver- 
tebrae; Insertion,  second  rib  below;  Action,  raise  the  ribs. 
Infra=costals  (are  inside  the  chest)  :  Origin,  surface  of  the 
rib  from  the  angle  to  the  tuberosity ;  Insertion,  second  rib 
below ;  Action,  same  as  the  intercostals. 


MUSCLES   OF   SHOULDEB — MUSCLES   OP   ARM.  127 

Triangle  Sternal  Muscle:   Origin,  ensiform  cartilage  and 

the  sternum;  Insertion,  the  third,  fourth,  fifth  and  tin' sixth 
costal  cartilages;   Action,  unknown. 

MUSCLES  OF  THE  SHOULDER. 

3G7  Deltoid:  Origin,  anterior  concavity  of  the  clavicle,  acro- 
mion, and  spine  of  scapula ;   Insertion,  V-shaped  surface  or 

deltoid  eminence  of  the  humerus;  Action,  abducts  the  arm. 
Supra=spinous :  Origin,  supra-spinous  fossa;  Insertion, 
upper  surface  of  greater  tuberosity  of  humerus;  Action,  the 
same  ;  is  especially  an  active  ligament. 
Infra=spinous  :  Origin,  infra-spinous  fossa;  Insertion,  mid- 
dle surface  of  the  greater  tuberosity  of  the  humerus  ;  Action. 
rotates  the  arm  outwards. 

Small  Round:  Origin,  middle  of  axillary  border  of  the 
scapula;  Insertion,  lower  surface  of  the  greater  tuberosity 
of  the  humerus ;  Action,  rotates  the  arm  outwards. 
Great  Round:  Origin,  axillary  border  of  scapula  near 
lower  angle;  Insertion,  posterior  ridge  of  the  bicipital 
groove  of  the  humerus ;  Action,  it  rotates  the  arm  inwards  ; 
is  also  an  adductor. 

Subscapular:  Origin,  subscapular  fossa ;  Insertion,  smaller 
tuberosity  of  humerus;  Action,  it  rotates  the  arm  inwards: 
is  also  an  active  ligament. 

MUSCLES  OF  THE  ARM— MUSCLES  OF  ANTERIOR 
REGION  OF  THE  ARM. 

368  Coracho=brachial :  Origin,  coracoid  process;  Insertion. 
border  of  the  humerus  (middle).  Action,  draws  the  arm 
forward. 

Biceps:  Origin,  long  head,  apex  of  glenoid  cavity  of 
scapula;  short  head,  coracoid  process;  Insertion,  bicipital 
tubercle  of  radius  (back  part).  Action,  flexes  the  arm  and 
supinates  the  forearm. 

Anterior  Brachial:  Origin,  lower  half  of  anterior  surface 
of  humerus  ;  Insertion,  base  of  coronoid  process  of  the  ulna. 
Action,  flexes  the  arm. 

MUSCLES  OF  THE   POSTERIOR    REGION  OF  THE  ARM. 

369  Triceps:  Origin,  long  head ;  axillary  border  of  scapula  be- 
low glenoid  cavity;  external  head  (external  vast):  poste- 
rior surface  of  humerus  above  spiral  groove ;  internal  head 
(internal  vast);  posterior  surface  of  the  humerus  below 
spiral  groove ;  Insertion,  base  of  olecranon  process  of  the 
ulna.     Action,    extends  the  forearm. 

Subanconeous  :  Origin,  lower  part  of  the  posterior  surface 
of  humerus ;  Insertion,  synovial  membrane;  Action,  draws 
the  synovial  membrane  from  between  the  bony  surfaces. 


128  MUSCLES  OF  FOREARM. 

MUSCLES  OF  THE  FOREARM. 

MUSCLES  OF  THE  ANTERIOR  REGION  OF  THE  FORE- 
ARM. 

SUPERFICIAL  LAYER. 

370  Round  Pronator:   Origin,  inner  condyle  of  the  humerus ; 
Insertion,  outer  surface  of  radius. 

Radiocarpal  Flexor :    Origin,  inner  condyle  of  humerus ; 
Insertion,  base  of  second  metacarpal  bone. 
Long    Palmar    (or   middle   radio-carpal   flexor) :     Origin, 
inner  condyle  of  the  humerus ;  Insertion,   anterior  annular 
ligament. 

Ulno=carpal  Flexor :  Origin,  inner  condyle  of  the  hume- 
rus and  olecranon  process  of  the  ulna ;  Insertion ,  pisiform 
bone. 

MIDDLE    LAYER. 

Superficial  Common  Flexor  of  Fingers:  Origin,  inner 
condyle  of  the  humerus,  coronoid  process  of  ulna  and  ob- 
lique line  of  the  radius  ;  Insertion,  lateral  borders  of  second 
phalanges. 

DEEP  LAYER. 

Deep  Common  Flexor:  Origin,  anterior  surface  of  ulna 
(upper  three- fourths)  ;  Insertion,-  bases  of  the  third  pha- 
langes.' 

Long  Flexor  of  Thumb :  Origin,  anterior  surface  of  radius 
(upper  three -fourths) ;  Insertion,  base  of  last  phalanx  of 
thumb. 

Square  Pronator :  Origin,  anterior  surface  of  ulna  (lower 
fourth) ;  Insertion,  anterior  surface  of  radius  (lower 
fourth). 

MUSCLES  OF  EXTERNAL  OR  RADIAL  REGION  OF 
THE  FOREARM. 

371  Long    Supinator:    Origin,  upper  part  of  outer  border  of 
humerus;  Insertion,  styloid  process  of  radius. 

Long  Radiocarpal  Extensor :  Origin,  lower  part  of  the 
outer  border  of  the  humerus ;  Insertion,  back  of  base  of  the 
second  metacarpal  bone. 

Short  Radiocarpal  Extensor  :  Origin,  external  condyle  of 
humerus ;  Insertion,  back  of  the  base  of  the  third  metacar- 
pal bone. 

Short  Supinator  :  Origin,  external  condyle  of  the  humerus 
Insertion,  upper  fourth  of  the  shaft  of  the  radius. 


MUSCLES   OF   FOREARM,    HAND,    AND    ULNAR    REGION.  L29 

MUSCLES  OF  POSTERIOR  REGION  OF  THE  FOREARM. 

SUPERFICIAL  LAYER. 

372  Anconeus:   Origin,  external  condyle  of  the  humerus  ;  Inser- 
tion, upper  fourth  of  the  outer  surface  of  tin-  ulna. 
Common  Extensor  of  Fingers :   Origin,  the  outer  condyle 

of  the  humerus ;  Insertion,  hy  a  middle  slip  into  the  bases 
of  the  second  phalange  and  by  two  lateral  slips  into  the 
bases  of  the  last  phalanges. 

Extensor  of  Little  Fingers:  Origin,  outer  condyle  of  the 
humerus;  Insertion,  unites  with  the  fourth  tendon  of  the 
common  extensor. 

Ulno=carpaI  Extensor:  Origin,  outer  condyle  of  the  hu- 
merus and  posterior  surface  of  ulna  (middle);  Insirtion. 
base  of  fifth  metacarpal  bone. 

DEEP    LAYER. 

373  Extensor  of  Metacarpal  Bone  of  Thumb  or  Long  Ab= 
ductor:  Origin,  middle  of  ulna,  interosseous  membrane, 
lower  part  of  radius;  Insertion,  base  of  the  metacarpal 
bone  of  the  thumb. 

Extensor  of  First  Phalanx  of  Thumb:  Origin,  middle  of 
ulna,  interosseous  membrane,  lower  part  of  radius  ;  Inser- 
tion, base  of  first  phalanx. 

Extensor  of  Second    Phalanx  of  Thumb:    Origin,   middle 
of  ulna:  Insertion,  the  base  of  the  second  phalanx. 
Extensor  of  Index    Finger:    Origin,   middle    of    the  ulna 
and   interosseous  membrane;    Insertion,    base    of    the    last 
phalanx. 

MUSCLES    OF    THE    HAND— MUSCLES    OF    EXTERNAL 
OR  RADIAL  OR  THENAR    REGION. 

374  Abductor  of  Thumb:  Origin,  annular  ligament  and  trape- 
zium; Insertion,  outer  part  of  the  first  phalanx. 
Opposing  or  Opponens  :  Origin,  annular  ligament  and  trape- 
zium; Insertion,  outer  border  of  first  metacarpal  bone. 
Short  Flexor  of  Thumb:  Origin,  anterior  head:  annular 
ligament,  trapezium  and  scaphoid;  posterior  head:  OS 
magnum,  trapezoid,  and  base  of  the  third  metacarpal  ;  In- 
sertion, outer  and  inner  tubercles  of  the  first  phalanx  of 
the  thumb. 

Adductor  of  the  Thumb:  Origin,  the  third  metacarpal  bone  : 
Insertion,  inner  tubercle  of  the  first  phalanx. 

MUSCLES  OF  THE   INTERNAL  OK   ULNAR  OR 
HYPOTHENAR  REGION. 

375  Short  or  Small  Palmar  JTuscle  :  Origin,  annular  ligament  ; 
Insertion,  the  skin. 

9 


130    MUSCLES  OF  PALMAR  REGION — MUSCLES  OF  ABDOMEN. 

Adductor  of  Little  Finger :  Origin,  annular  ligament  and 
pisiform  bone ;  Insertion,  outer  tubercle  of  the  base  of  first 
phalanx  of  little  finger. 

Short  Flexor  of  Little  Finger :  Origin,  annular  ligament 
and  pisiform  bone  ;  Insertion ,  outer  tubercle  of  the  base  of 
the  first  phalanx. 

Flexor  of  the  Metacarpal  Bone  of  the  Little  Finger,  or 
Opponens :  Origin,  unciform  process;  Insertion,  inner  bor- 
der of  fifth  metacarpal  bone. 

MUSCLES  OF  THE  MIDDLE  OR  PALMAR  REGION. 

376  Lumbrical  Muscles:  Origin,  tendons  of  the  deep  flexor; 
Insertion,  extensor  tendons  of  the  finger;  Action,  assists 
interosseous  muscles  in  extending  the  fingers. 
Interosseous  Muscles  :  Origin,  lateral  surfaces  of  metacar- 
pal bones;  Insertion,  base  of  the  first  phalanx :  Action,  ab- 
ductors and  adductors. 

MUSCLES  OF  EXTERIOR  OF  THE  ABDOMEN. 

377  Great  Oblique  or  External  Oblique:  Origin,  iliac  crest, 
Poupart's  ligament,  superior  spinous  process,  spine  and 
angle  of  the  pubis ;  Insertion,  linea  alba,  outer  surface  of 
the  eight  lower  ribs ;  Action,  compresses  the  viscera,  de- 
presses the  lower  ribs. 

Small  or  Internal  Oblique:  Origin,  iliac  crest,  Poupart's 
ligament,  crest  of  pubis  ;  Insertion,  linea  alba,  free  border  of 
the  costal  cartilages  of  the  asternal  ribs;  Action,  the  same. 
Transverse  :  Origin,  lumbar  aponeurosis  and  through  it  to 
the  spinous  and  transverse  processes  of  the  lumbar  verte- 
bras, iliac  crest,  crest  of  pubis  ;  Insertion,  linea  alba,  internal 
surface  of  the  eight  lower  ribs  and  their  cartilages  ;  Action, 
the  same. 

Abdominal  Straight:  Origin,  crest  of  pubis;  Insertion, 
outer  surface  of  the  cartilages  of  the  middle  ribs ;  Action, 
same ;  flexes  the  trunk. 

Pyramidal:  Origin,  crest  of  pubis;  Insertion,  linea  alba; 
Action,  is  the  tensor  of  the  linea  alba. 

MUSCLES  OF  THE  INTERIOR  OF  THE  ABDOMEN. 

378  Diaphragm  :  Origin,  bodies  of  first  four  lumbar  (the  right 
or  anterior  pillar  descends  to  the  fourth,  the  left  or  posterior 
pillar  reaches  only  the  third)  ;  internal  and  external  arcuate 
ligaments  ;  inner  surface  of  the  asternal  ribs  and  of  the  false 
ribs :  Insertion,  cordiform  tendon ;  Action,  increases  the 
depth  of  the  chest  and  raises  the  lower  ribs. 

Square  Lumbar:    Origin,  iliac  crest,  ilio-lumbar  ligament, 


MUSCLES   OF   THIGH.  L3j 

transverse  processes  of  the  Lumbar  vertebrae;   Insertion,  lasl 
rib;  Action,  depresses  the  Lower  rib  or  steadies  ii. 
Small  Psoas:   Origin,  bodies  of  last  dorsal  and  firsl  Lumbar 
vertebra?;  Insertion,  ilio-pectineal  eminence;  Action,  is  tin- 
tensor  of  the  iliac  fascia. 

Large  Psoas  Huscle:  Origin,  bodies  ami  transverse  pro- 
cesses of  last  dorsal  and  all  the  Lumbar  vertebrae  ;  Insi  rtion, 
small  trochanter  of  femur;  Action,  flexes  the  thigh  and 
rotates  it  outwards. 

Iliac  fluscle:  Origin,  iliac  fossa:  Insertion,  small  tro- 
chanter; Action,  the  same  as  psoas. 

MUSCLES  OF  ANTERIOR  REGION  OF  THIGH. 

379  Tensor  of  Femoral  Fascia:   Origin,  anterior  superior  spine 

of  the  ilium;   Insertion,  femoral  fascia. 

Sartorius:  Origin,  auterior  superior  spinous  process  of  the 
ilium;  Insertion,  upper  part  of  crest  of  tibia;  Action,  tiexes 
the  leg'  aud  crosses  it  in  front  of  the  other  leg;  it  tiexes  the 
thigh  also. 

Quadriceps  Extensor: 

1st.  Straight:  Origin,  anterior  inferior  spinous  process  of 
the  ilium  and  adjoining  groove  ;  Insertion,  patella  and  tuber- 
cle of  the  tibia  ;  Action,  extends  the  leg. 
2d.  External  Vast:  Origin,  root  of  great  trochanter,  rough 
line  and  outer  lower  branch  of  this  rough  line ;  Insertion. 
tendon  of  straight  muscle  and  outer  border  of  the  patella. 
3d.  Internal  Vast:  Origin,  inner  surface  of  the  femur, 
rough  line  and  inner  lower  branch  of  this  line ;  Insertion, 
tendon  of  straight  muscle  and  inner  border  of  the  patella. 
4th.  Crureus:  anterior  surface  of  the  femur:  Insertion, 
upper  border  of  the  patella. 

Sub=Crureus:  Origin,  lower  part  of  anterior  surface  of  the 
femur;  Insertion,  synovial  capsule. 

MUSCLES   OF  THE  INTERNAL  REGION  OF  THE 
THIGH. 

380  Gracilis:  Origin,  branches  of  the  pubis  and  ischium;  In- 
sertion, crest  of  the  tibia:  Action,  is  an  adductor  of  tin' 
thigh  and  a  flexor  of  the  leg. 

Pectineus :  Origin,  ilio-pectinal  Line;  Insertion,  line  from 
small  trochanter  to  rough  line  :  Action,  is  an  adductor  and 
a  rotator  outwards. 

Long  Adductor:    Origin,  anterior  surface  of  the  pubis;    In- 
sertion, middle  third  of  the  rough  line  of  the  femur. 
Short  or  Small   Adductor:    Origin,  anterior  surface  of  the 
pubis;  Insertion,  upper  third  of  rough  line  of  femur. 
Great  Adductor  :   Origin,  anterior  surf  ace  of  the  branches 
of  the  pubis  and  ischium  and  internal  borders  of  the  ttlber- 


132  MUSCLES   OR   LEG,    FOOT  AND   GLUTEAL   REGION. 

osity  of  the  ischium ;  Insertion ,  whole  of  rough  line  and 
tubercle  on  inner  condyle  of  the  femur. 
Action,  they  adduct  the  thigh. 

MUSCLES   OF   THE   ANTERIOR   REGION    OF   THE  LEG. 

381  Anterior  Tibial  Muscle :  Origin,  upper  two-thirds  of  the 
outer  surface  of  the  tibia;  Insertion,  inner  cuneiform 
bone.  Action,  flexes  the  foot  and  turns  its  inner  border 
upwards. 

Extensor  Huscle  of  Great  Toe :   Origin,   middle  third  of 

fibula  and  interosseous  membrane;  Insertion ,  base  of  the 

second  phalanx  of  great  toe. 

Long  Extensor  of  the  Toes :   Origin,  upper  two-thirds  of 

fibula  and  interosseous  membrane;  Insertion,  base  of  the 

second  and  third  phalanges. 

Third  or  Small  Peroneal :   Origin,  is  a  division  of  the  long 

extensor  of  the  toes ;  Insertion,  base  of  the  last  metatarsal 

bone;  Action,  flexes  the   foot  and  turns  the  outer  border 

upwards. 

MUSCLES  OF  THE  EXTERNAL  REGION  OF  LEG. 

382  Short  Peroneal:   Origin,   lower  half  of   fibula;  Insertion, 
base  of  last  metatarsal  bone;  Action,  extends  the  foot. 
Long  Peroneal :  Origin,  upper  half  of  the  fibula;  Insertion, 
base  of  the  first  metatarsal  bone ;  Action,  extends  the  foot 
and  turns  the  outer  border  of  the  foot  upwards. 

MUSCLE  OF  DORSAL  REGION  OF  FOOT. 

383  Short  Extensor  of  the  Toes :  Origin,  calcaneum  and 
cuboid;  Insertion,  tendon  of  the  long  extensor  of  the  toes. 

MUSCLES  OF  THE  GLUTEAL  REGION. 

384  Great  Gluteal:  Origin,  iliac  crest,  posterior  sacro-sciatic 
ligament,  sacrum  and  coccyx ;  Insertion,  crural  fascia  and 
outer  branch  of  rough  line  of  femur;  Action,  rotates  the 
thigh  outwards  and  supports  the  trunk  upon  the  femur. 
JTiddle  Gluteal :  Origin,  between  the  two  curved  lines  of 
innominate  bone ;  Insertion,  outer  surface  of  great  trochan- 
ter; Action,  the  same. 

Small  Gluteal :  Origin,  below  the  inferior  curved  line  ;  In- 
sertion, interior  border  of  the  great  trochanter ;  Action,  ro- 
tates the  thigh  inwards. 

Pyriform  :    Origin,  anterior  surface  of  the  sacrum;  Inser- 
tion, upper  border  of  great  trochanter;  Action,  rotates  the 
thigh  outwards. 
Superior  Gemellar:    Origin,  spine  of  ischium;  Insertion, 


MUSCLES  OF  POSTERIOR  REGION  OF  THIGH  AND  LEG.  133 

tendon  of  internal  obturator;  Action,  rotates  the  thigh  out- 
wards. 

Inferior  Qemellar  :  Origin,  tuberosity  of  the  ischium ;  In- 
sertion, tendon  of  internal  obturator;  Action,  the  same. 
Internal  Obturator:  Origin,  inner  surface  of  obturator 
membrane  and  margin  of  obturator  foramen  ;  Insertion,  up- 
per border  of  the  great  trochanter;  Action,  the  same. 
Square  Femoral :  Origin,  tuberosity  of  the  ischium  ;  Inser- 
tion, posterior  border  of  the  great  trochanter;  Action,  the 
same. 

External  Obturator:  Origin,  outer  surface  of  obturator 
membrane  and  margin  of  obturator  foramen;  Insertion, 
digital  fossa  on  inner  surface  of  great  trochanter ;  Action, 
the  same. 

MUSCLES  OF  THE   POSTERIOR  REGION  OF 
THE  THIGH. 

385  Biceps  :  Origin,  long  head,  tuberosity  of  the  ischium ;  short 
head,  middle  third  of  rough  line  of  femur;  Insertion,  head 
of  the  fibula;  Action,  flexes  the  leg. 

Semitendinous  :  Origin,  tuberosity  of  the  ischium  ;  Inser- 
tion, anterior  tuberosity  of  tibia;  Action,  flexes  the  leg. 
Semi=membranous  :  Origin,  tuberosity  of  ischium  ;  Inser- 
tion, 1st,  through  Winslow's  ligament  to  external  condyle 
of  femur ;  2d,  posterior  surface  of  head  of  the  tibia ;  3d, 
groove  on  inner  tuberosity  of  the  tibia;  Action,  flexes  the 
leg. 

MUSCLES  OF   THE   POSTERIOR   REGION  OF  THE  LEG. 

SUPERFICIAL   LAYER. 

386  Gastrocnemius:  Origin,  by  two  heads  above  the  condyles 
of  the  femur ;  Insertion,  tendon  of  Achilles. 

Soleus :   Origin,  outer  head:  upper  third  of  the  posterior 

surface  of  fibula ;  inner  head :    oblique  line  of  the  tibia ; 

Insertion,  tendon  of  Achilles  and  through  it  to  the  calca- 

neum. 

Plantaris :   Origin,  outer  condyle  of  the  femur:   Insertion, 

inner  border  of  the  tendon  of  Achilles  ;  Action,  extends  the 

foot. 

DEEP   LAYER. 

Popliteal:     Origin,    groove   on  outer  surface  of  the  outer 

condyle  of  the  femur;    Insertion,  posterior  surface  of  the 

tibia   above   oblique   line;  Action,  flexes  the    leg:   it  is  an 

active  ligament. 

Long   Flexor   of  Toes :    Origin,   posterior  surface  of   the 

tibia;  Insertion,  bases  of  the  last  phalanges. 

Posterior  Tibial  :  Origin,  interosseous  membrane,  tibia  and 


134  MUSCLES  OF   FOOT — PECULIARITIES  OF  MUSCLES. 

fibula ;  Insertion,  scaphoid  and  inner  cuneiform  bone  ;  Action, 
extends  the  foot  and  turns  its  inner  border  upwards. 
Long  Flexor  of  Great  Toe :      Origin,  posterior  surface  of 
the  fibula ;  Insertion,  base  of  the  second  phalanx. 

MUSCLES  OF  THE  FOOT.— MUSCLES  OF  THE  INTERNAL 
REGION— MUSCLES  OF  GREAT  TOE. 

387  Adductor  of  Great  Toe:  Origin,  internal  tuberosity  of 
ealcaneum,  internal  cuneiform  and  first  metatarsal ;  Inser- 
tion, inner  side  of  the  first  phalaux. 

Short  Flexor  of  Great  Toe :   Origin,  cuboid  and  external 

cuneiform  bones;    Insertion,  base  of  the  first  phalanx  by 

two  tendons. 

Adductor  of  Great  Toe  :   Origin,  calcaneo-cuboid  ligament, 

base  of  the  second  and  third  metatarsal ;  Insertion,  outer 

side  of  base  of  first  phalanx. 

Transverse  Muscle :    Anterior  extremities   of  metatarsal 

bones ;  Insertion,  outer  side  of  base  of  the  first  phalanx. 

MUSCLES  OF  THE  EXTERNAL  PLANTAR  REGION.— 
MUSCLES  OF  THE  LITTLE  TOE. 

388  Abductor  of  Small  Toe :  Origin,  ealcaneum  and  fifth  meta- 
tarsal ;  Insertion,  outer  side  of  base  of  last  phalanx. 
Short  Flexor  of  Small  Toe :  Origin,  cuboid  and  fifth  meta- 
tarsal; Insertion,  base  of  the  first  phalanx. 

MUSCLES  OF  THE  MIDDLE   PLANTAR  REGION. 

389  Short  Flexor:   Origin,  ealcaneum  and  internal  annular  lig- 
ament; Insertion,  borders  of  the  second  phalanges. 
Accessory  Flexor:  Origin,  ealcaneum;  Insertion,  outer  bor- 
der of  tendons  of  long  flexor  of  toes. 

Lubricals  :   Origin,  angle  of  tendons  of  long  flexor  of  toes  ; 
Insertion,  inner  side  of  the  first  phalanges. 
Interosseous:   Origin,  lateral  surface  of  metatarsal  bones; 
Insertion,  bases  of  first  phalanges  of  toes. 


PECULIARITIES  OF  THE  HUSCLES    IN  PARTICULAR. 

(Ninety -two  Muscles.) 
390  Flexor  Muscles  are  always  more  numerous. 

MUSCLES  OF  THE  BACK. 

The  Trapezius  is  remarkable  for  its  large  surface. 
The  Great  Dorsal  also. 


CRANIAL  REGION — MUSCLES  OF  PACE — MAXILLARY  REGION.       L35 

The  Complexus  originates  from  the  transverse  processes, 

and  is  inserted  in  the  occipital  close  to  the  middle  line;  it  is 
the  reverse  with  most  of  the  other  muscles  of  the  region. 
The  Cervical  Digastric  is  one  of  the  few  double-bellied 
muscles.  The  others  are  the  digastric,  the  great  oblique  of 
the  eyeball,  the  occipito-frontal,  the  omo-hyoid. 
The  Spinal  Erector  is  remarkable  for  the  multiplicity  of  its 
insertions  through  fasculi  which  are  attached  to  all  the  bony 
prominences  of  the  hack:  spinous  processes,  transvcrx- 
processes,  articular  processes,  neck  of  the  ribs,  angles  of 
ribs. 

The  Posterior  Straight  and  Oblique  Muscles  arc  really 
the  active  ligaments  of  the  articulations  of  the  head  with 
the  vertebral  column. 

CRANIAL  REGION. 

The  Occipito=frontal  is  the  largest  donble-bellied  muscle. 

It  is  separated  from  the  periosteum  by  a  loose  layer  of 
connective  tissue  which  forms  a  real  serous  bursa. 

Its  origin  is  bony;  its  insertion  is  cutaneous. 

MUSCLES  OF  THE  FACE. 

All  the  muscles  of  the  face  and  of  the  cranial  region,  ex- 
cept the  Masseter,  are  cutaneous  muscles  ;  that  is,  they  have 
a  bony  origin  and  a  cutaneous  insertion. 

All  such  cutaneous  muscles  (including  the  platysma  of 
the  neck)  are  supplied  by  the  facial  nerve. 

All  the  muscles  of  the  face  form  groups  around  the  ori- 
fices, and  are  dilators  or  constrictors  of  those  orifices. 
The  Orbicular  Muscle  of  the  Lips  is  the  only  thoroughly 
cutaneous  muscle,  since  it  is  not  connected  with  bone  at  any 
point. 

The  Palpebral  Orbicular  is  noticeable  for  its  action,  which 
spreads  the  tears  over  the  cornea  and  at  the  same  time 
directs  them  towards  the  lachrymal  lake  at  the  inner  angle, 
where  they  are  absorbed  by  the  lachrymal  points. 
The  Buccinator  is  perforated  by  Steno's  Duct. 

TEMPORO-MAXILLARY  REGK  >N. 

The  flasseter  is  the  only  muscle  forming  a  part  of  the  face 
which  is  not  a  cutaneous  muscle;  it  is  supplied  by  the  fifth 
pair. 

The  Temporal  is  remarkable  for  its  strength,  for  its 
unique  insertion  in  the  strong  coronoid  process,  Cor  it-  en- 
casement in  a  fibro-osseous  fossa. 


136      MAXILLARY  REGION — MUSCLES  OF  NECK — HYOID  REGION. 


PTERYGO -MAXILLARY  REGION. 

The  External  Pterygoid : 

Has  two  heads,  between  which  is  found  the  internal  max- 
illary artery. 

It  is  inserted  also  into  the  fibro-cartilage  of  the  temporo- 
maxillary  articulation  and  compels  that  cartilage  to  follow 
the  movement  forward  of  the  condyle. 

MUSCLES    OP    THE    SUPERFICIAL   REGION 
OF  THE  NECK. 

391  The  Platysma  is  the  largest  cutaneous  muscle,  containing 
the  most  muscular  fibres. 

The  Sterno=cleido  Mastoid  : 

Is  a  most  important  surgical  muscle. 

It  divides  the  side  of  the  neck  into  two  large  triangles. 

Its  relations  with  the  large  vessels  of  the  neck  are  of  the 
greatest  importance,  as  will  be  described  in  the  surgical  an- 
atomy of  the  neck. 

MUSCLES  OF  THE  SUPRA-HYOID  REGION. 

The  Digastric: 

Is  one  of  the  four  double-bellied  muscles. 

It  gives  its  name  to  a  surgical  region,  the  digastric  tri- 
angle. 

The  StyIo=hyoid  is  noticeable  because  its  tendons  are 
perforated  by  the  Digastric. 

The  Mylo=hyoid  forms  the  floor  of  the  mouth ;  all  that 
is  below  it  is  outside  of  the  mouth ;  all  that  is  above  it  is 
in  the  mouth. 

Its  fibres  cross  to  the  other  side. 
It  forms  a  sort  of  diaphragm. 
The  Geniohyoid  is  above  the  mylo-hyoid,  i.  e.,  inside  the 

mouth. 

MUSCLES  OF  THE  INFRA-HYOID  REGION. 

The  Sternohyoid  is  a  guide  in  tracheotomy. 
The  Omo=hyoid  : 

Is  a  double-bellied  muscle. 
It  is  remarkable  for  its  irregular  course. 
It  is   connected  in  its  middle  with   the  cervical   fascia, 
which  is  itself  adhered  to  the  Subclavian  vein. 


MUSCLES  OF  THE  CHEST,  SHOULDER  AND  ARM.  137 


MUSCLES  OF  THE  CHEST. 

The  Great  Pectoral : 

Is  remarkable  for  its  size,  shape,  structure. 

Its   lower   border   forms  the    anterior   boundary  of  the 
axilla. 

The  Small  Pectoral  divides  the  course  of  the  axillary  ves- 
sels into  three  portions :  above  it,  under  it  and  below  it. 
The  Subclavian  is  an  active  ligament. 
The  Great  Serrate  is  noticeable  for  its  extent. 
The  Intercostals  are    remarkable  for  the  difference  in  the 
direction  of  the  fibres  in  the  externals  and  the  internals. 
The  Sternal  Triangle  Muscle  is  noticeable  for  the  difficulty 
to  understand  its  use. 

MUSCLES  OF  THE  SHOULDER. 

392  The  Deltoid  : 

Is  really  the  only  abductor  muscle  of  the  arm. 

It  is  supplied  by  one  nerve  only,  the  circumflex. 
The  Supra=spinous,  the  Infra=spinous,  the  Small   Round 
and   the   Subscapular  are  really  active   ligaments  of  the 
Scapulo-humeral  articulation. 

MUSCLES  OF  THE  ARM. 

The  Coracobrachial : 

Is  the  guide  to  tne  axillary  and  brachial  arteries. 

It  is  perforated  by  the  Musculo-spiral  nerve. 
The  Biceps — Has  two  heads — The  long  Tendinous  Head 
runs  through  a  joint,  the  only  instance  of  the  kind. —  Its 
insertion  is  very  limited,  but  very  strong. — The  biceps  is 
the  guide  to  the  brachial  artery. —  It  gives  off  an  expansion 
which  separates  the  basilic  vein  from  the  brachial  artery. 
The  Triceps  Extensor —  Has  three  very  distinct  heads  :  an 
only  instance. —  The  Outer  and  the  Inner  Heads  are  sep- 
arated by  the  spiral  groove  of  the  humerus  containing  the 
musculo-spiral  nerve. —  Its  insertion  to  the  base  of  the 
olecranon  process  is  very  limited. 

MUSCLES  OF  ANTERIOR    REGION    OF   THE  FOREARM. 

393  All  the  four  muscles  of  the  superficial    layer  originate  from 
the  internal  condyle. 

The  Long  Palmar  is    inserted    into   a    fascia,    the    palmar 
fascia,  an  only  instance. 
The  Ulno=Carpal  Flexor: 

Presents  at  its    origin    an    arch    under    which  passes  the 

ulnar  nerve. 

The  tendon  of  insertion  presents  a  sesamoid  hone,  the  pisi- 


138  MUSCLES  OF  THE  FOREARM  AND  HAND. 

form  (like  the  patella,  the  flexors  of  the  thumb  and  of  the 
big  toe). 

It  is  the  guide  to  the  Ulnar  Artery. 

MUSCLES  OF  THE  DEEP  LAYER  OF  THE 
FOREARM. 

The  Superficial  Flexor  forms  a  layer  of  itself. 

The    Deep  Flexor  and  the  Long    Proper  Flexor  of   the 

Thumb  form  a  separate  layer  of  themselves. 

All  the  tendons  of  the  flexors  are  surrounded  at  the  wrist  by 
a  large  common  synovial  sac  which  sends  a  sheath  to  the 
thumb  and  to  the  little  finger,  but  not  to  the  other  fingers. 

In  the  fingers  the  tendons  of  the  Deep  flexor  perforate 
those  of  the  superficial  flexors. — In  the  fingers  the  tendons 
have  a  strong  sheath  which  stops  at  the  base  of  the  last 
phalanx. — The  Square  Pronator  forms  a  layer  of  itself. 

MUSCLES  OF  THE  EXTERNAL  REGIONS  OF  THE 
FOREARM. 

The  Long  Supinator   forms  the   outer  boundary   of   the 

outer  groove  of  the  elbow. — It  has  a  long,  flat  tendon. — It 

is  the  guide  to  the  radial  artery. 

The    Radiocarpal   Extensors    are  crossed  over  by    the 

deep  muscles  of  the  posterior  region. 

The  Short  Supinator : 

Is  wrapped  around  the  radius. 

It  is  traversed  by  the  radial  nerve. 

MUSCLES    OF    THE    POSTERIOR    REGION   OF   THE 
FOREARM. 

The  four  muscles  of  the  superficial  layer  originate  from 
the  external  condyle. 
The  Anconeus  is  an  active  ligament. 

The  tendons  of  the  extensors  are  joined  by  transverse 
bands. 

The  four  muscles  of  the  deep  layer  go  to  two  fingers  only, 
the  thumb  and  the  index  ;  three  to  the  thumb,  the  extensors 
of  the  last  phalanx,  of  the  first  phalanx,  of  the  first  meta- 
carpal bone :  one  to  the  index  finger,  the  extensor  of  the 
index. 

MUSCLES  OF  THE  HAND. 

The  Opposing  muscle  of  the  thumb  is  possessed  only  by 
man  and  monkey. 

The  two  heads  of  the  Short  Flexor  of  the  thumb  are 
separated  by  the  tendon  of  the  Long  Flexor. 


MUSCLES  OF  THE  VERTEBRAL  REGION  AND  ABDOMEN.  139 

The  Adductor  muscle  of  tin-  thumb  is  noticeable  for  its 
broad  origin  and  narrow  insertion. 

All  those  muscles  are  inserted  into  two  small  sesamoid 
bones. 

The  Lumbrical  Muscles  are  of  a  peculiar  shape. — They 
originate  from  a  tendon,  the  flexor,  and  are  inserted  into  ,-i 
tendon,  the  extensor. 

The  Interosseous  are  also  peculiar  in  their  uneven  dis- 
tribution to  the  fingers. 

MUSCLES  OF  THE  VERTEBRAL  REGION. 

394  The  Anterior  Straight  Huscles  are  active  ligaments. 

The  Anterior  Scalene  and  its  Tubercle  is  the  guide  to  the 
Subclavian  Artery  and  Vein,  to  the  Brachial  Plexns,  to  the 
Phrenic  Nerve,  to  the  Vertebral  Artery,  to  the  Pleura. 

MUSCLES  OF  THE  EXTERIOR  OF  THE  ABDOMEN. 

The  Pyramidal : 

Is  the  tensor  muscle  of  the  white  line. 
The  Abdominal  Straight:   Is  encased  in  a  fibrous  sheath. 

It  presents  transverse  bands. 

The  inner  borders  limit  the  white  line  and  are  guides  in 
laparatomies. 

The  Epigastric  and  the  Internal  Mammary  anastomose  in 
its  substance. 
The  Obliques  and  the  Transverse  : 

Are  broad  and  flat. —  Their  fibres  are  differently  directed 
in  each  layer. —  They  are  continuous  with  those  of  the 
opposite  side,  through  the  fascia?,  passing  in  front  and  be- 
hind the  straight  muscle. 

The  External  Oblique  forms  Ponpart's  ligament. 
The    Lower    Fibres    of   the  Internal    Oblique  and  of   the 
transverse  form  the  Cremaster  Muscle. 

The  Posterior  Border  of  the  two  obliques  form  the  an- 
terior boundary  of  a  slot,  limited  behind  by  the  anterior 
border  of  the  common  mass  of  the  Spinal  Erector;  impor- 
tant surgically. 

MUSCLES  OF  THE  INTERIOR  OF  THE  ABDOMEN. 

The  Diaphragm  : 

Is  the  most  perfect  of  all  the  diaphragms  of  the  body 
(The   others   are   the   mylo-hyoid    and   the  elevator  of    the 
amis.) 

Its  situation  is  remarkable  and  unique,  in  the  interior  of 
the  body  and  dividing  it  into  two  large  compartments. 

It  is  broad,  flat,  curved. 

Its  centre  is  aponeurotic  ;   it  is  a  kind  of  digastric. 


140  MUSCLES  OF  PELVIS  AND  THIGH. 

It  presents   several   openings :    oesophagus   and   inferior 
cava. 

Its  centre  is  attached  to  the  pericardium. 

It  contracts  from  the  centre  to  the  periphery. 

It  receives  a  spinal  nerve  on  each  side  and  no  other. 

It  is  the  essential  muscle  of  respiration. 
The  Small  Psoas : 

Is  sometimes  wanting. 

Is  the  tensor  muscle  of  a  fascia,  like  the  long  palmar  and 
the  tensor  of  the  femoral  fascia. 
The  Large  Psoas : 

Is  the  softest  muscle  in  the  body. 

It  contains  the  lumbar  plexus  in  its  substance. 

It  forms  the  lateral  boundaries  of  the  inlet  of  the  pelvis. 

It  is  one   of   only  two   muscles   which   may   suppurate 
primarily. 

It  contains  the  crural  nerve  in  its  sheath. 
The  Iliac : 

Is  also  a  soft  muscle. 

It  also  may  suppurate  primarily. 

MUSCLES  OF  THE  INTERIOR  OF  THE  PELVIS. 

395  The  Elevator  of  the  Anus  : 

Closes  the  cavity  of  the  pelvis  after  the  manner  of  a  small 
diaphragm,  perforated  only  by  the  rectum. 
The  Pyriform  : 

Is  covered  over  by  the  large  nerves  of  the  Sacral  Plexus. 

It  originates  in  the  pelvis,  but  terminates  outside  of  it. 
The   Internal    Obturator :    also   originates   in  the  pelvis, 
but  terminates  outside  of  it. 

No  other  muscles  do  this  but  these  two. 

MUSCLES  OF  THE  ANTERIOR  REGION  OF  THE  THIGH. 

The  Tensor  of  the  Femoral  Fascia. 

Is  the  largest  of  the  tensors  (the  other  four  are  the  long 
palmar,  the  pyramidal  of  abdomen,  the   small  psoas,  the 
plantaris). —  It  is   also   almost   entirely   encased   into  the 
femoral  fascia  (like  the  abdominal  straight). 
The  Sartorius : 

Is  the  longest  and  the  narrowest  muscle  in  the  body. 

It  crosses  the  thigh  and  the  femoral  vessels  obliquely. 

It  is  a  most  important  surgical  muscle. 
The  Quadriceps  Extensor : 

Is  the  only  quadruple  muscle  in  the  body. 

Its  tendon  is  the  patellar  ligament. 

The  patella  is  a  sesamoid  bone  developed  in  the  tendon. 

The  deep  fibres  called  the  subcrureus  are  inserted  into  the 
synovial  membrane. 

Its  arterial  branches  are  numerous  and  large. 


MUSCLES  OF  THIGH,  LEG,  FOOT  AND  GLUTEAL  REGION.  HI 

MUSCLES  OF  THE  INTERNAL  REGION  OF  THE  THIGH. 

The  Gracilis : 

Is  the  muscle  that  projects  under  the  skin  of  the  inner 
region  of  the  thigh  when  the  thighs  are  open. 

It  joins  the  Sartorius  and  the  semi-membranous  to  form 
the  goose's  paw. 
The  Three  Adductors: 

Are  the  muscles  of  walking. 

They  are  all  triangular  in   shape. 

They  all  originate  from  the  pubis  and  ischium. 

They  are  all  attached  to  the  rough  line  of  the  femur. 

The  great  adductor  presents  a  special  long  tendon. 

It  also  forms  part  of  Hunter's  Canal. 

The  Pectineus : 

Is  truly  also  an  adductor. 

MUSCLES  OF  ANTERIOR  REGION  OF  THE  LEG. 

The  Extensor  of  the  Great  Toe : 

Is  covered  over  above  by  the  Anterior  Tibial  and  the 
Common  Extensor. 

Its  tendon  is  a  guide  to  the  Dorsal  Artery. 
The  Third  Peroneal : 

Is  only  a  part  of  the  Common  Extensor. 

MUSCLES  OF  THE  EXTERNAL   REGIONS   OF  THE  LEG. 

The  Peroneals : 

Wind  around  the  lower  part  of  the  bone  and  this  causes 
the  twist  in  the  fibula. 

The  musculo-cutaneous  nerve  winds  through  their  upper 
extremity. 

Are  the  analogue  of  the  radio-carpal  extensors. 
The  Tendon  of  the  Long  Peroneal  crosses   obliquely  the 
sole  of  the  foot  and  is  the  tensor  muscle  of  the  arch   of 
the  foot. 

MUSCLES  OF  THE  BACK  OF  THE  FOOT. 

The  Short  Extensor  of  the  Toes  : 

Its  tendons  are  inserted  into  the  tendons  of  another 
muscle  (like  the  lumbricals  and  the  interosseous,  the  acces- 
sory flexor  of  the  toes). 

MUSCLES  OF  THE  GLUTEAL  REGION'. 

396  The  Great  Gluteal  : 

Is  the  thickest  muscle  in  the  body. 
It  forms  the  buttock. 


142  MUSCLES   OF   THIGH  AND   LEG. 

The  Pyriform  "|      Are  specially  the  pelvic  tro- 

The  Internal  Obturator  !  chanterian  muscles  which  are 
The  External  Obturator  [the  active  ligaments  of  the 
The  Square  Femoral  J  the  Coxo-fenioral  articulation. 
The  Gemellar  Muscles: 

Are  part  of  the  internal  obturator. 

The  other  Gemellar  Muscles  of  the  body  belong  to  the 
calf  of  the  leg. 

MUSCLES  OF  THE  POSTERIOR  REGION  OF  THE  THIGH. 

The  Biceps : 

Is  the  analogue  of  the  biceps  of  the  arm. 

There  are  only  two  biceps  in  the  body  (arm  and  thigh). 

It  forms  the  outer  upper  boundary  of  the  popliteal  space. 

The  internal  saphenous  nerve  is  on  the  inside  of  it. 
The  Semitendinous: 

Forms  the  inner  upper  boundary  of  the  popliteal  space. 

It  contributes  to  form  the  goose's  paw. 
The  Semimembranous : 

Forms  more  particularly  the  upper  inner  boundary  of  the 
popliteal  space. 

It  is  the  guide  to  the  popliteal  artery. 

MUSCLES   OF  THE    SUPERFICIAL    POSTERIOR  REGION 

OF  THE  LEG. 

The  Gastrocnemii  and 
The  Soleus : 

Form  a  triceps,  tbe  Sural  Triceps. 

The  tendon  is  called  the  Achilles  Tendon. 
The  Piantaris : 

Is  a  peculiar  little  muscle. 

It  corresponds  to  the  long  palmar  of  the  forearm. 

It  is  the  tensor  muscle  of  Achilles  Tendon. 

MUSCLES    OF   THE  DEEP  LAYER  OF    THE  POSTERIOR 
REGION  OF  THE  LEG. 

The  Popliteal : 

Is  the  analogue  of  the  anconeus. 

It  is  an  active  ligament. 

It  forms  the  floor  of  the  lower  part  of  the  popliteal 
space. 

The  other  muscles  of    this  layer  are  remarkable  for  the 
change  in  their  relative  situations  above  and  below. 
The  Long  Flexor  of    the   Great  Toe  in  the  leg  is  on  the 
outside,  and  in  the  foot  is  on  the  inside. 
The  Long  Flexor  of  the  Toes  is  in  the  leg  on  the  inside, 
and  in  the  foot  is  on  the  outside. 


MUSCLES  WHICH  ARK  INTERESTING  OR  IMPORTANT.  143 

The  Posterior  Tibial   is  in  the  Leg  in  the  middle  and  18  OB 
the  inside  on  the  fool . 

M  USCLES  OF  TH  E  PL  ANT  A  R  R  EGION. 

Are  similar  to  those  of  the  hand. 
There  is  no  opposing  muscle. 
There  is  an  additional  flexor,  the  Short  Flexor. 

There  is  an  Accessory  Flexor,  peculiar  in  that  it  is  inserted 
into  the  tendon  of  the  long  common  flexor. 

It  is  the  only  muscle  inserted  to  a  tendon  by  fleshy  fibres. 


riUSCLES  WHICH  ARE  SPECIALLY  INTERESTING 
OR  IMPORTANT. 

(  Th  irty-eigh  t  Muscles .  J 

397  In  the  Back: — Spinal  Erector  —  Posterior  Straight  and 
Oblique. 

In  the  Head: — Occipitofrontal. — Muscles  of  the  Face — 
Internal  Pterygoid. 

In  the  Keck: — Platysma, — Sterno-mastoid, — Digastric, — 
Mylo-hyoid, — Omo-hyoid. 

In  the  Chest: — Great  Pectoral, — Great  Dorsal, — Inter- 
costals. 

In  the  Shoulder:  —  Deltoid, —  Supra-Spinous, —  Infra-Spi- 
nous, — Small  Round, — Subscapular. 

In  the  Arm: — Coraco -brachial, — Biceps. 

In  the  Forearm: — Ulno-carpal  Flexor, — Radio-carpal 
Flexor, — Tendons  of  the  Flexors  and  their  Synovial  Sac. — 
Long  Supinator, — Short  Supinator. 

In  the  Hand: — Opposing, — Lumbricals. 

In  the  Vertebral  Region: — Anterior  Scalene. 

In  the  Abdomen: — Diaphragm, — Psoas  Iliac 

In  the  Anterior  Region  of  the  Thigh: — Sartorins, — Great 
Adductor. 

In  Anterior  and  Lot'  rat  Regions  of  Leg: — Proper  Extensor, 
— Long  Peroneal. 

In  the  Gluteal  Region: — The  Pelvi-trochanterian. 

In  the  Posterior  Region  of  tin  Thigh: — Biceps. — Semi- 
membranous. 

In  the  Posterior  Regiqn  of  the  L<<j: — None  specially. 

In  the  Plantar  Ret/ion — Accessory  Flexor. 


144       MUSCLES  OF  SURGICAL  IMPORTANCE — BLOOD. 

riUSCLES  OF  SPECIAL  SURGICAL  IMPORTANCE. 

(Twenty-five  Muscles.) 

398  In  the  Head;  Masseter,  on  account  of  its  action  in  dislo- 
cations. 

In  the  Week: — Sterno-mastoid :  it  is  the  guide  to  the  large 
vessels  of  the  neck. — Digastric :  it  is  a  special  surgical  re- 
gion.— Mylo-hyoid:  it  closes  the  mouth  below. — Omo- 
hyoid :  it  is  adherent  to  the  subclavian  vein. 

In  the  Chest: — Great  Pectoral :  it  forms  the  anterior  bound- 
ary of  the  axilla. — Great  Dorsal :  it  forms  the  posterior 
boundary  of  the  axilla. 

In  the  Shoulder: — Detloid  :  it  is  the  only  abductor  muscle 
of  the  arm. 

In  the  Arm: — Coraco-brachial :  it  is  the  guide  to  the  ax- 
illary artery. — Biceps  :  it  is  the  guide  to  the  brachial  artery. 

In  the  Forearm: — Long  Supinator :  it  is  the  guide  to  the 
radial  artery. — Ulno-carpal  Flexor :  it  is  the  guide  to  the 
ulnar  artery. — Tendon  of  the  Flexor :  on  account  of  the 
synovial  sac. — Short  Supinator :  on  account  of  the  radial 
nerve. 

In  the  Vertebral  Region:  Anterior  Scalene:  it  is  the  guide 
to  many  important  structures. 

In  the  Exterior  of  Abdomen: — Straight:  it  is  the  guide  in 
laparotomies. 

In  the  Abdomen: — Psoas-iliac:  it  is  the  seat  of  abscesses. 

In  the  Anterior  Region  of  the  Thigh: — Sartorius  :  it  is  the 
guide  to  the  large  vessels  of  the  region. 

In  the  Anterior.  Region  of  the  Leg: — Proper  Extensor:  it 
is  the  guide  to  the  anterior  tibial  artery  and  the  dorsal 
artery. 

In  the  External  Region  of  the  Leg: — Long  Peroneal :  on 
account  of  the  musculo-cutaneous  nerve. 

In  Gluteal  Region : — Pyriform:  it  is  the  guide  to  the  glu- 
teal artery,  the  ischiatic  artery,  the  pudic  artery  and  the 
great  sciatic  nerve. 

In  the  Posterior  Region  of  the  Thigh: — Biceps:  it  is  the 
guide  to  the  external  popliteal  nerve. — Semi-membranous  : 
it  is  the  guide  to  the  popliteal  artery. 

In  the  Posterior  Region  of  the  Leg: — Posterior  Tibial :  it  is 
the  guide  to  the  posterior  tibial  artery. 

In  the  Plantar  Region: — Muscles  in  relation  with  the 
course  of  the  external  plantar  artery. 


BLOOD. 


399  Anatomical  Elements:  Are  mainly  the  Red  and  the  White 
Blood  Corpuscles. 


BLOOD   CORPUSCLES.  L45 

Also  Blood  Plates  or  Hematoplasts. 
Also  Free  Nuclei. 
Also  Pigments. 
Also  Crystals. 
Also  Hemaglobin. 

RED  BLOOD  CORPUSCLES. 

400  Color :  They  are  of  an  amber  color  when  examined  singly 
under  the  microscope. 

Situation  :  In  the  centre  of  the  current. 

Number:  300  to  one  white. 

Size  :  0.002  to  0.003  of  a  line. 

Shape:  Biconcave  disc  with  rounded  borders,   or  double 

contour  edge. — The  centre  is  depressed  and  looks  like  a 

nucleus,  but   there   is  no  nucleus. — When  viewed  in  any 

quantity  on  a  glass  slide  under  the  microscope  they  arrange 

themselves  into  pillars  or  columns. 

Structure :  They  are  composed   of   gelatinous   substance. 

They  have  no   nucleus. 

Movements  :  They  have  no  active  movement  of  their  own. 

They  are  only  very  elastic  and  extensible  and  alter  their 

shape  in  their  course  through  small  capillaries,  but  soon 

return  to  their  fundamental  form. 

WHITE  BLOOD  CORPUSCLES. 

401  Color  :  They  are  white. 

Situation  :  Along  the  walls  of  the  vessel  mostly. 
Number  :  One  to  300  red. 

Are  more  numerous  after  eating,  especially  after  eating 
animal  substance. 

Are  more  numerous  in  the  splenic  and  hepatic  veins. 

They  are  scarce  in  the  hepatic  artery. 
Size  :  They  are  larger  than  the  red. 

Some  are  large  and  some  are  small;  the  small  ones  are 
sometimes  half  the  size  of  the  large  ones. 
Shape :  They  are  spherical,   but  may  alter  their  shape  in 
their  course. 
Structure:  They  are  composed  of  protoplasm. 

They  show  a  nucleus  by  using  acetic  acid  ;  it  occupies  the 
greater  part  of  the  corpuscle. 

The  larger  white  corpuscles  usually  possess  t\v<>  or  more 
nuclei. 

They  resemble  pus  corpuscles. 

They  frequently  have  granular  contents. 
Movements:  They  have  active  movements,  as  explained  in 
describing  cells  in  general. 
10 


146  BLOOD   PLATS — STRUCTURE  OF  ARTERIES  AND  VEINS. 

BLOOD  PLATS  OR  HEMATOPLATS. 

402  Size :  They  are  one-third  to  one-half  smaller  than  the  red 
blood  corpuscles. 

Shape :  They  are  large  granules,  Or  pale,  circular  or  oval 
discs. 

FREE  NUCLEI. 
Number  :  They  exist  in  great  numbers. — (Ranvier.) 

BLOOD  PIGMENT  OR  HEMATINE. 

Color  :  Is  dark  brown  or  black. 
Shape  :  Is  a  powder. 

STRUCTURE  OF  ARTERIES. 

403  General  Structure.     Arteries  are  formed  of  three  coats : 
1st.  The  External  or  Fibrous  Goat  is  the  most  resistant. 

2d.  The  Middle  or  Elastic  and  Muscular  Goat  is  formed  of 
alternate  layers  of  elastic  and  muscular  tissues. 

The  fibres  pursue  a  longitudinal  and  a  circular  course 
around  the  vessel ;  the  muscular  fibres  are  of  the  smooth 
kind. 

The  elastic  fibres  are  fine  fibres  and  broad  fibres, 
which  present  round  or  oval  openings  and  form  the 
so-called  Perforated  or  Fenestrated  Membrane. 
3d.  The  Internal  or  Serous  Goat  is  composed  of  a  thin  and 
delicate  basement  membrane,  lined  with  a  single  layer  of 
elongated  polygonal  cells. 

404  Structure  in  Particular,  According  to  Size: 

1st.  In  large  arteries  the  external  fibrous  coat  is  compara- 
tively thin ;— the  middle  or  elastic  is  the  thickest ; — the  in- 
ternal is  also  thick. 

2d.  In  the  middle-sized  arteries  the  fibrous  coat  is  thickest. 
3d.  In  the  smallest  arteries  the  middle  coat  consists  of 
muscular  tissue  only  and  is  the  thickest ; — the  smaller  the 
artery,  the  more  abundant  is  the  muscular  tissue. 
Vessels  :  are  the  Vasa  Vasorum. — The  arteries  come  from 
the  small  neighboring  arteries  and  not  from  the  trunk  they 
supply. — The  veins  empty  into  the  contiguous  larger  venous 
branches. 

STRUCTURE  OF  VEINS. 

405  They  have  the  same   general   structure  as  the  arteries,  with 
few  but  important  differences. 

The  External  Fibrous  Goat  is  thicker  and  more  resistant 
than  that  of  the  arteries ; — it  gradually  increases  in  thick- 
ness from  the  smallest  to  the  largest. 


CAPILLARIES — DESCRIPTION   OF  ARTERIES.  147 

The  Middle  or  Musculo-elastic   Coat  is  comparatively  thin  ; 
— the  .smaller  the  vessel,  the  thinner  the  coat. 

The  Infernal  or  Serous  Coat  is  like  that  of  the  arteries. 

It  forms  valves. 
Venous  Sinuses  are  venons  channels  which  are  dug  in  the 
substance  of  an  organ  and  which  are  deprived  of  external 
and  middle  coats,  these  being  replaced  by  the  tissue  of  the 
organ  itselT ;  the  interior  is  lined  by  the  internal  coat  of 
veins. 
Vessels  of  Veins  :  same  as  for  arteries. 


CAPILLARIES. 


406  Direct  Communication  exists  between  arteries  and  veins  without 
the  intervention  of  capillaries,  as  in  matrix  of  nails,  tip  of 
nose,  fingers  and  toes. 

The  Smallest  Capillaries  are  found  in  the  nervous  central 
system  and  the  largest  in  the  marrow  of  bones. 

Serous  Capillaries,  i.  e.,  vessels  admitting  only  the  serum 
of  the  blood  without  blood  corpuscles,  do  not  exist. 

ARTERIAL  CAPILLARIES 

Are  composed  of  a  thin,  delicate  layer  of  smooth  muscu- 
lar fibres — and  of  a  lining  of  longitudinal  nucleated  endo- 
thelial cells. 

VENOUS  CAPILLARIES 

Have  the  same  structure,  except  that  the  muscular  fibres 
are  much  fewer. 

CAPILLARIES    PROPER  OR  INTERMEDIATE 
CAPILLARIES. 

They  are  formed  of  a  single  layer  of  transparent  elon- 
gated cells  or  plates  with  oval  nuclei, — united  together  by 
thin  layers  of  a  cement  substance. 

They  are  endowed  with  vital  contractility  (Strieker). 

If  capillaries  are  abnormally  distended  the  cement  sub- 
stance between  the  cells  is  liable  to  yield  and  give  rise  to 
minute  holes  or  mouths,  and  thus  permit  blood  corpuscles 
to  pass  through. 

DESCRIPTION  OF  THE  ARTERIES  IN  PARTICULAR. 

407  Remark.  Only  the  branches  of  some  consequence  in  oper- 
ating or  in  establishing  collateral  circulation  will  be  con- 
sidered. 


148  CARDIAC  AND  PULMONARY  CIRCULATION. 

Divisions.  There  are  three  different  and  independent  cir- 
culatory circuits :  the  circulation  of  the  heart,  the  circula- 
tion of  the  lungs  and  the  general  or  systemic  circulation. 

CARDIAC  CIRCULATION. 

The  Arteries  are  the  two  Cardiac  or  Coronary  Arteries, 
which  are  the  first  branches  giving  off  from  the  aorta. 

Owing  to  the  contracted  condition  of  the  heart  during  the 
ventricular  systole,  the  blood  enters  these  vessels  during 
the  cardiac  diastole,  which  is  the  opposite  with  all  the  other 
arteries. 

They  run  along  the   interventricular   and    auriculo -ven- 
tricular grooves,  and  anastomose  freely. 
The  Veins  are : 

1st.  The  Great  Cardiac  or  Coronary  Vein  or  Sinus,  which 
returns  almost  all  the  blood  of  the  heart. 

It  runs  in  the  anterior  interventricular  and  the  left 
auriculo -ventricular  grooves. 

And  it  opens  into  the  right  auricle  above  and  to  the  inner 
side  of  the  ascending  cava. 

Its  orifice  is  guarded  by  an  effective  valve,  the  Valve  of 
the  Thebesius. 

2d.  The  Veins  of  Thebesius,  are  small  venules  from  the 
right  side  of  the  heart  which  open  directly  into  the  right 
auricle. 

PULMONARY  CIRCULATION. 

408  It  comprises  the  Pulmonary  Circulation  Proper,  for  the 
oxygenation  of  the  blood,  and  the  Bronchial  Circulation, 
for  the  nutrition  of  the  bronchi  and  the  tissues  of  the  lungs. 

PULMONARY  CIRCULATION  PROPER. 

The  Artery  is  the  Pulmonary  Artery,  which  carries  black  or 
venous  blood. 

It  originates  from  the  right  ventricle. 

It  winds  around,  and  passes  under,  the  first  part  of  the 
aorta  and  divides  into  the  right  and  left  pulmonary  ar- 
teries. 

The  right  subdivides  into  three  large  branches,  one  for 
each  lobe. 

And  the  left  into  two  large  branches  only. 

Their  divisions  follow  the  bronchi  and  finally  form  a  del- 
icate plexus  beneath  the  epithelium  of  the  the  air  vesicles. 
The  Veins  succeed  the  arterial  capillaries  and  form  the 
Four  Pulmonary  Veins,  the  two  right  or  upper  veins  and 
the  two  left  or  lower. 

They  also  follow  the  bronchi  and  open  into  the  left 
auricle  of  the  heart. 

Their  orifices  have  no  valves ;  they  carry  red  blood. 


BRONCHIAL  AND  SYSTEMIC  CIRCULATION — AORTA.  1  4!> 


BRONCHIAL  CIRCULATK  )X. 

The  Arteries  are  the  two  Bronchial  Arteries. 

They  originate  from  the  aorta. 

They  follow  the  bronchi  and  their  divisions,  but  do  not 
reach  the  air  vesicles. 

Their  small  size  compared  to  the  lung  is  easily  accounted 
for  by  the  small  amount  of  solid  tissue  the  lungs  contain 
and  the  nature  of  that  tissue,  which  everywhere  else  also 
possesses  very  few  capillaries. 

The  Veins  are  the  Bronchial  Veins;  they  follow  the  arteries 
and  open  in  the  azygos. 

GENERAL  OR  SYSTEMIC  CIRCULATION— AORTA. 

409  Origin  :  from  the  left  ventricle. 

Course  :  It  describes  an  Arch  which  presents  an  ascending, 
a  transverse,  and  a  descending  portion,  and  which  ends  on 
the  left  side  of  the  third  dorsal  vertebra. 
It  then  becomes  the  Thoracic  Aorta,  which  gradually  comes 
in  front  of  the  vertebra?  and  passes  through  an  opening  in 
the  diaphragm  opposite  the  first  lumbar  vertebra. 
It  is  then  called  the   Abdominal  Aorta,  and   is   situated 
almost  on  the  middle  line  in  front  of  the  vertebra?,  and  di- 
vides opposite  the   fourth  lumbar   vertebra  into  the  two 
Common  Iliac  arteries. 
Situation  or   Relation. 

The  Arch  is  in  relation  : 

In  Front,  with  Left  Innominate  Vein  and  the  sternum. 

Behind,  with  the  trachea. 

Below,  with  the  divisions  of  the  pulmonary  arteries,  the 
auricles  and  the  root  of  the  left  lung. 

Above,  with  the  branches  originating  from  it. 

On  the  Outside,  with  the  Superior  Cava. 

On  the  Inside,  with  origin  or  trunk  of  the  pulmonary 
artery. 

The   Thoracic   Aorta   is   in    relation    with   the   following 
organs : 

The  Vertebral  Column  :  on  the  left  above  and  on  the  mid- 
dle line  below. 

The  CEsophagus :  it  crosses  it  obliquely,  so  that  above  it 
is  on  the  median  line,  whereas  the  aorta  is  on  the  left;  in 
the  middle  of  the  course  the  oesophagus  is  right  over  the 
aorta,  and  below  the  oesophagus  is  on  the  left  of  the  median 
line  and  the  aorta  is  on  the  median  line. 

The  Great  Azi/(/os  Vein  is  on  the  right  of  the  aorta. 

The  Thoracic  Duct  is  also  on  top  of  it. 

The  Pleura  :    on  the  left  side  only. 
The  Abdominal  Aorta  is  in  relation  : 

In  Front,  with  the  mesentery. 


150  AORTA — INNOMINATE  ARTERY — CAROTID. 

Behind,  with  the  vertebral  column. 
On  the  Right,  with  the  Inferior  Cava. 
On  the  Left,  with  the  mesentery. 

BRANCHES  OF  THE  ARCH  OF  THE  AORTA. 

410  They  are  the  Innominate,  the  Left  Carotid  and  the  left  Sub- 
clavian. 

INNOMINATE  ARTERY. 

Situation  or  Relations.     It  is  in  relation : 

In  Front,  with  the  Left  Innominate  Vein,  the  sternum 
and  the  sterno -clavicular  articulation. 

Behind,  with  the  trachea. 

Externally,  with  the  Left  Superior  Cava. 

Internally,  with  the  Left  Common  Carotid. 
Branches:    It  gives  rise  occasionally   only  to  the  Middle 
Thyroid,  which  ascends  in  front  of  the  trachea  and  is  dis- 
tributed to  the  thyroid  body. 

COMMON  CAROTID. 

411  Origin  :  The  Bight  originates  from  the  innominate,  but  the 
Left  comes  directly  from  the  aorta. 

The  Left  is  therefore  longer  and  more  deeply  seated. 
Course:  It  ascends  along  the  vertebral  column  to  the  up- 
per border  of  the  thyroid  cartilage,  where  it  divides. 
Situation  or  Relations. 

In  Front,  below  it  is  entirely  covered  by  the  sterno-mas- 
toid ;  in  the  Middle  it  is  covered  only  by  the  edge  of  that 
muscle ;  above,  it  is  not  covered  at  all  by  it,  but  by  the 
veins,  the  fascia  and  skin. 

Behind,  with  the  vertebral  column,  the  pneumo- gastric 
and  the  sympathetic. 

Internally,  with  the  trachea,  oesophagus,  larynx  and  thy- 
roid body. 

Externally,  with  the  internal  jugular  vein,  which  overlaps 
it  considerably. 

Branches  :  Opposite  the  upper  border  of  the  thyroid  carti- 
lage it  divides  into  the  External  and  the  Internal  Carotids. 
It  gives  rise  to  no  collateral  branches. 

EXTERNAL  CAROTID. 

412  Origin  :  Upper  border  of  the  thyroid  cartilage. 
Situation  and  Course  :  It  is  situated  at  first  a  little  to  the 
inner  side  of  the  internal  carotid, — then  ascends  outside  of 
the  stylo-hyoid  and  digastric ; — it  is  crossed  by  the  hypo- 
glossal nerve ; —  it  then  penetrates  the  parotid  gland  on  the 
inner  side  of  the  ramus  of  the  jaw ; — and  opposite  the  tern- 


INTERNAL  CAROTID.  1  5 1 

poro-maxillary  articulation  it  divides  into  the  Internal 
Maxillary  and  the  Temporal. 

413  Branches:  Are  the  Superior  Thyroid,  the  Lingual,    Facial, 
Occipital,  Internal  Maxillary  and  the  Temporal. 

1.  The  Superior  Thyroid  is  distributed  to  the  upper  angle 
of  the  thyroid  body. 

2.  The  Lingual  in  apart  of  its  course  runs  parallel  to  the 
great  horn  of  the  hyoid  bone,  one-quarter  of  an  inch  above 
it —  it  is  covered  by  the  fibres  of  the  hyo-glossus  muscle. — 
The  hypoglossal  nerve  is  above  it  and  parallel  to  it. 

3.  The  Facial  crosses  the  posterior  part  of  the  submaxil- 
lary gland. — Strikes  the  face  at  the  anterior  inferior  angle 
of  the  masseter. — Runs  towards  the  commissure  of  the  mouth. 
— Then  in  the  labio-genial  fold  towards  the  wing  of  the 
nose, —  and  then  in  the  naso-genial  fold  to  the  internal  an- 
gle of  the  eye,  where  it  is  called  the  Angular. —  It  inoscu- 
lates with  the  terminal  branch  of  the  ophthalmic  called  the 
JSfasal. 

It  gives  off  the  two  Labial  or  Coronary  arteries  and  the 
Submental. 

4.  The  Occipital  is  situated  deeply  under  the  sterno-mas- 
toid  and  trapezius,  to  the  inner  side  of  the  mastoid  process. 

It  supplies  the  occipital  region. 

It  gives  off  the  Descending  Cervical  (or  Princeps  Cervices) 
which  anastomoses  with  the  Posterior  Ascending  Cervical 
(or  Profunda  Cervicis)  of  the  Superior  Intercostal. 

5.  The  Internal  Maxillary  is  directed  from  the  articulation 
obliquely  forwards  and  inwards, —  it  passes  between  the 
two  heads  of  the  internal  pterygoid  muscle. — It  passes 
through  the  spheno-palatine  foramen. — It  is  distributed  to 
the  nasal  cavities  under  the  name  of  the  SpJieno-palatin?  or 
Nasal. 

It  gives  off  the  Middle  Meningeal,  which  enters  the  cra- 
nium through  the  spinous  foramen; — the  Descend ing  Pala- 
tine to  the  soft  palate; — the  Inferior  Dental  to  the  lower 
teeth. 

6.  The  Temporal  is  distributed  to  the  temporal  region. 

It  gives  off  the  Transverse  Facial,  which  is  sometimes 
quite  large. 

INTERNAL  CAROTID. 

414  Origin  :  Upper  border  of  thyroid  cartilage. 

Course  :  It  ascends  along  the  vertebral  column  to  the  base  of 
the  skull. — It  then  passes  through  the  Carotid  Canal  of  the 
petrous  bone. — It  then  proceeds  forward  through  the  Cavern- 
ous Sinus. — At  the  end  of  the  sinus  it  curves  backwards, — 
gives  rise  to  the  ophthalmic, — and  divides  into  its  terminal 
branches,  the  Anterior  and  the  Middle  Cerebral  Arteries. 


152  SUBCLAVIAN   ARTERY. 

Situation  or  Relations  in  the  Neck. 

In  Front,  with  the  veins  and  fascia,  then  the  stylo-hyoid 
and  digastric,  then  the  parotid  gland. 

Behind,  with  the  vertebral  column,  the  pnenmo- gastric, 
sympathetic. 

Internally,  with  the  larynx,  pharynx,  tonsil. 

Externally,  with  the  internal  jugular  vein. 

415  Branches :  Are  the  Ophthalmic,  Anterior   and  Middle  Cere- 
orals. 

1.  The  Ophthalmic  passes  into  the  orbit  through  the  optic 
foramen,  on  the  outer  side  of  the  optic  nerve. — It  crosses 
over  the  nerve  to  reach  the  inner  wall  of  the  orbit, — which 
it  follows  to  the  internal  angle ; — there  it  is  called  the  Nasal 
and  inosculates  with  the  angular  of  the  facial. 

It  gives  off  the  Lachrymal  to  the  lachrymal  gland, — An- 
terior Ciliary  to  the  iris, — the  Long  Ciliary  to  the  iris, — 
the  Posterior  Short  Ciliary  to  the  choroid, — the  Central  Ar- 
tery of  the  Retina. 

2.  The  Anterior  Cerebral  is  distributed  to  the  anterior  part 
of  the  great  interhemispheric  fissure  and  to  the  anterior 
lobes  of  the  brain. 

It  communicates  with  its  fellow  by  means  of  the  Anterior 
Communicating. 

3.  The  Middle  Cerebral  is  distributed  to  the  Sylvian  fissure 
and  to  the  middle  lobe  especially. 

It  gives  off  the  Posterior  Communicating,  which  anas- 
tomoses with  the  posterior  cerebral  from  the  basilar. 

SUBCLAVIAN  ARTERY. 

416  Origin  :  The  Eight  originates  from  the  Innominate  Artery. 

The  Left  originates  directly  from  the  Aorta. 

It  is  therefore  longer  and  more  deeply  seated  than  the 
right. 

Course  :  It  arches  over  the  pleura, — passes  between  the  two 
scalenes, —  and  terminates  at  the  lower  border  of  the  first 
rib. 

Divisions :    It  has   three   portions :     the   first  inside    the 
scalenes.,  the  second  between  the   scalenes   and  the  third 
outside  the  scalenes. 
Situation  and  Relations : 
The  First  Portion,  or  Inside  the  Scalenes,  is  in  relation: 

In  Front,  with  the  subclavian  vein,  the  pneumo -gastric 
and  the  recurrent. 

Behind,  with  the  cervical  plexus. 

Above,  with  the  Thoracic  Duct,  or  the  Right  Lymphatic 
Duct. 

Below,  with  the  pleura. 

Internally,  with  the  common  carotid. 

Externally ,  with  the  border  of  the  scalenes. 


SUBCLAVIAN  ARTERY.  153 

The  Second  Portion,  or  Between  the  Scalenes,  is  in  rela- 
tion : 

In  Front,  with  the  anterior  scalene  and  its  tubercle, 
which  separates  it  from  the  subclavian  vein. 

Behind,  with  the  middle  scalene. 

Above,  with  the  brachial  fiexus. 

Below,  with  the  groove  of  the  first  rib. 
The  Third  Portion,  or  Outside  the  Scalenes,   is  in  rela- 
tion: 

In  Front,  with  the  clavicle. 

BeJi hid,  with  the  brachial  fiexus. 

Beloir,  with  the  first  rib. 

Above,  with  the  skin,  the  subclavian  muscle. 
417  Branches :    They   all  originate  to  the   inner  side  of    the 
scalene  muscles. 

They  are :  the  Vertebral,  the  Inferior  Thyroid,  the  Supe- 
rior Intercostals,  the  Internal  Mammary,  the  Anterior  Scapu- 
lar and  the  Posterior  Scapular  (Transverse  Cervical). 

Three  originate  from  a  common  trunk,  called  the  Thyroid 
Axis:  the  Inferior  Thyroid,  the  Anterior  Scapular  and  the 
Posterior  Scapular. 

1.  The  Vertebral  enters  the  foramen  of  the  tranverse  pro- 
cess of  the  sixth  cervical  vertebra. — It  ascends  through  all 
the  foramina  above. — It  winds  around  the  atlas. — It  enters 
the  cranium  between  the  occipital  bone  and  the  posterior 
arch  of  the  atlas. — It  joins  its  fellow  and  forms  the  Basilar 
Artery. 

The  Vertebral  gives  off  the  Anterior  and  Posterior  Spinal 
Arteries  to  the  oblong  medulla  and  spinal  cord, — and  the 
Inferior  Cerebellar  to  the  cerebellum. 

The  Basilar  Artery  is  situated  on  the  middle  line  of  the 
Varolian  bridge — it  divides  into  the  two  Posterior  Oi  n  brals. 

These  receive  the  Posterior  Communicating  Artery  from 
the  internal  carotid,  thus  completing  the  Circle  of  Willis, 
which  is  formed  in  front  of  the  anterior  cerebral  and  the 
anterior  communicating  from  the  internal  carotid. 

The  basilar  gives  off  also  the  Middle  and  Superior  Cere- 
bellar to  the  cerebellum. 

2.  The  Inferior  Thyroid  passes  behind  the  internal  jugular 
vein  and  internal  carotid  artery. — It  is  distributed  to  tin- 
lower  angle  of  the  thyroid  gland. 

3.  The  Anterior  Scapular  follows  the  posterior  border  of 
the  clavicle. — It  is  distributed  to  the  supra  and  infra-sphious 
fossa?. 

4.  The  Posterior  Scapular  or  Transverse  Cervical  crosses 
obliquely  backwards  over  the  subclavian  artery  and  the 
nervesof  the  brachial  plexus.— It  passes  under  the  trapezius 
and  descends  along  the  posterior  border  of  the  scapula, 
under  the  name  of  Posterior  Scapular.— At  the  inferior 
angle  of  the  scapular  it  anastomoses  with  the  subscapular 
artery. 


154  AXILLARY  ARTERY — BRACHIAL  ARTERY. 

5.  The  Superior  Intercostal  is  distributed  to  the  two 
or  three  superior  intercostal  spaces. 

It  gives  off  the  Posterior  Ascending  or  Deep  Cervical, 
which  anastomoses  with  the  descending  cervical  of  the  oc- 
cipital. 

6.  The  Internal  Mammary  descends  behind  the  intercostal 
cartilages,  one-quarter  of  an  inch  to  the  outer  side  of  the 
sternum. 

It  penetrates  the  abdominal  straight  muscle,  being  called 
the  Descending  Epigastric. 

It  terminates  by  inosculating  with  the  deep  ascending 
epigastric  from  the  external  iliac. 

AXILLARY  ARTERY. 

418  Origin  :  Lower  border  of  the  first  rib. 

Course :  It  begins  at  the  lower  border  of  the  first  rib, 
below  the  subclavian  and  clavicle. — It  traverses  the  axillary 
space  in  its  axis.— It  terminates  at  the  lower  border  of  the 
tendons  of  the  great  pectoral  and  great  dorsal  muscles, 
where  it  becomes  the  brachial. 
Situation  or  Relations  :  It  is  in  relation  : 

In  Front,  with  the  vein,  the  nerves  and  the  fascia. 

Behind,  with  the  joint  and  the  humerus. 

Above,  with  the  correo -brachial,  which  is  the  guide  to  it. 

Below,  with  the  long  head  of  the  triceps  and  the  tendon 
of  the  great  dorsal. 

419  Branches :  Are  the  Long  Thoracic,  the  Subscapular  and 
the  Posterior  Circumflex. 

1.  The  Long  Thoracic  runs  between  the  small  pectoral  and 
the  great  serrate,  to  which  it  is  mostly  distributed. 

2.  The  Subscapular  is  a  very  large  and  important  branch. 
It  anastomoses  freely  with  the  perforating  branches  of  the 
intercostals  and  the  scapulars. 

3.  The  Posterior  Circumflex  is  large.  It  winds  around  the 
posterior  part  of  the  surgical  neck  of  the  humerus; — it 
anastomoses  with  the  scapulars  and  the  deep  brachial. 

BRACHIAL  ARTERY. 

420  Origin  :  Lower  border  of  the  tendon  of  the  great  pectoral. 
Course  :  It  descends  vertically  to  below  the  articular  line 
of  the  elbow  in  front  of  the  insertion  of  the  biceps. — It  di- 
vides therein  to  the  Radial  and  the  Ulnar. 

Situation    or    Relations :     Its   relations   vary    above    the 

elbow  and  at  the  elbow. 

Above  the  Elbow,    it  is  in  relation : 

Internally,  with  the  median  nerve,  which  crosses  it  ob- 
liquely, the  fascia,  the  skin. 

Externally,  with  the  anterior  brachial. 


RADIAL  ARTERY — ULNAR  ARTERY.  L55 

Anteriorly,  with  the  border  of  the  biceps,  which  is  a  guide 
to  it. 

Posteriorly,  with  the  humerus. 
At  the  Bend  of  the  Elbow  : 

It  occupies  the  inner  groove. 

It  is  in  relation  : 

In  Front,  with  the  Median  Vein,  the  Expansion  of  the 
biceps  and  the  Two  Brachial  Veins. 

Behind,  with  the  Anterior  Brachial. 

Externally  with  the  Tendon  of  the  Biceps. 

Internally,   with  the  Median  Nerve  and  the  Round  Pro- 
nator. 

421  Branches :  are   the   Superior  and  Inferior   Deep  Brachial 
and  the  Great  Anastomotic. 

1.  The  Superior  Deep  Brachial  runs  in  the  spiral  groove, 
together  with  the  musculo-spiral  nerve,  and  anastomoses 
with  the  recurrents. 

2.  The  Inferior  Deep  anastomoses  with  the  ulnar  recur- 
rent arteries. 

3.  The  Great  Anastomotic  does  the  same. 

RADIAL  ARTERY. 

422  Origin  :  From  the   bifurcation   of  the  brachial,  below  the 
bend  of  the  elbow. 

Situation  and  Course :  It  follows  the  radius  and  the  long 

supinator  muscle,  which  is  the  guide  to  it; — it  winds  around 

the  outer  part  of  the  wrist,  under  the  extensor  tendons  of 

the  thumb  ; — it  passes  through  the  first  interosseous  space  ; 

—  it  enters  the  palm  of  the  hand,  where  it  becomes  the  Deep 

Palmar  Arch. 

Branches.     It  gives  off : 

1st.  The    Recurrent    Radial    Artery,    which   anastomoses 

with  the  deep  brachial. 

2d.  The  Superficial    Palmar  or  Volar  to  the  Superficial 

Palmar  Arch. 

3d.  The  Carpals. 

4th.   Metacarpals. 

5th.   Dorsal  and   Palmar  Arteries  of  the  thumb  and  index 

fingers. 

6th.  The  Deep  Palmar  Arch,  which  is  situated  behind  all 

the  tendons,  resting  upon  the  upper  part  of  the  metacarpal 

bones. 

The  Arch  is  completed  by  a  dee])  branch  from  the  ulnar. — 

It  gives  off  the  Interosseous  and  Collateral  arteries  of  the 

fingers. 

ULNAR  ARTERY. 

423  Origin:    From  the   bifurcation  of  the  brachial,  below  the 
bend  of  the  elbow. 


156  BRANCHES  OF  THE  AORTA. 

Situation  and  Course:  It  passes  under  the  round  pro- 
nator and  superficial  flexor; — it  follows  the  ulno-carpal 
flexor,  which  is  the  guide  to  it,  to  the  pisiform  bone  ; — there 
it  crosses  the  palm  of  the  hand  in  front  of  the  flexor  tendons  ; 
—  it  forms  the  Superficial  Palmar  Arch. 

424  Branches.     It  gives  off : 

1st.  The  Anterior  Ulnar  Recurrent. 

2.  The   Posterior   Ulnar    Recurrent,    which   anastomoses 
with  the  inferior  deep  brachial  and  the  great  anastomotic. 
3d.  The  Anterior  Interosseous. 

4th.  The  Posterior  Interosseous,  which  gives  off  the  In- 
terosseous Recurrent,  which  anastomoses  like  the  others. 
5th.  The  Anterior  and  Posterior  Carpal  arteries. 
6th.  The  Deep  Communicating  Artery  to  the  Deep  Palmar 
Arch. 

7th.  The  Superficial  Palmar  Arch,  which  gives  off  the 
Digitals  which  join  the  interosseous  to  form  the  Collaterals 
of  the  Fingers. 

BRANCHES  OP  THE  THORACIC  AORTA. 

425  It  gives  off:  1st,  the  Bronchial  to  the  bronchi; — 2d,  the 
Intercostals ,  to  the  nine  lower  intercostal  spaces; — these 
give  off  the  Lateral  Perforating  Branches,  which  anastomose 
with  the  Subscapular  (axillary). 

BRANCHES  OF  THE  ABDOMINAL  AORTA. 

426  They  are: — 1st,  the  Coeliac  Axis:  It  originates  on  aline 
with  the  upper  border  of  the  neck  of  the  pancreas ; —  it 
divides  into  the  Gastric,  distributed  along  the  smaller  curva- 
ture of  the  stomach; — the  Hepatic,  which  enters  the  liver 
through  the  transverse  fissure; — the  Splenic,  which  runs 
along  the  upper  border  of  the  pancreas  and  ends  in  the 
spleen. 

2d.  The  Superior  Mesenteric.  It  originates  along  the  in- 
ferior border  of  the  neck  of  the  pancreas. 

It  is  distributed  to  all  the  small  intestines  and  to  the 
right  half  only  of  the  large  intestines. 

3d.  The  Inferior  Mesenteric.  It  originates  lower  down  — 
it  is  distributed  to  the  left  half  only  of  the  large  intestines ; 
—  on  the  rectum  it  divides  into  the  two  Superior  Hemor- 
rhoidal arteries,  which  extend  as  low  down  as  the  anus. 
4th.  The  Supra=renals.  They  are  distributed  to  the  supra- 
renal capsules. 

5th.  The  Renals.  They  are  very  large; — the  right  is  the 
lower; — they  are  situated  behind  the  vein  and  in  front  of 
the  pelvis  of  the  ureter. 

6th.  The  Two  Spermatic.  They  originate  below  the  renal ; 
— they  descend  along  the  psoas  muscle; — they  run  through 


COMMON  ILIAC — INTERNAL  ILIAC.  \')1 

the  inguinal  canal ; — they  descend  into  the  scrotum  ; — they 
are  distributed  to  the  epididymis  and  testicles. 
7th.  The  Two  Phrenic.     They  are  distributed  to  the  dia- 
phragm. 

8th.  The    Lumbars.     They   are    distributed    between    the 
psoas  and  square  lumbar  muscles. 

9th.  The  Middle   Sacral.     It  descends   along  the   middle 
line  of  the  sacrum. 

COMMON  ILIAC. 

■427  Origin  :    From  the  bifurcation  of  the  aorta  at  the  fourth 
lumbar  vertebra. 

Course:  It  runs  along  the  psoas  muscle  to  the  sacro-iliac 
junction. — Here   it  divides  into  the  Internal  and  External 
Iliacs. 
Situation  or  Relations : 

In  Front,  it  is  covered  by  the  peritoneum  and  ureter. 

Behind,  it  rests  on  the  psoas. 

Internally,  with  the  vein. 
Branches :  None. 

INTERNAL  ILIAC. 

428  Origin  :  From  the  bifurcation  of  the  common  iliac  opposite 
the  sacro-iliac  articulation. 

Course :  It  descends  toward  the  upper  part  of  the  great 

sacro-sciatic  notch. — There  it  divides  into  visceral  branches, 

parietal    intra-pelvic    branches    and    parietal    extra-pelvic 

branches. 

Situation  or  Relations : 

In  Front,  with  the  peritoneum  and  the  ureter. 

Behind,  with  the  sacro-iliac  junction. 

Internally,  with  the  vein. 

429  The  Visceral  Branches  are  : 

The  Three  Vesicals. 

The  Uterine,  a  very  large  branch,  penetrating  at  the  neck. 

The  Vaginal. 
The  Parietal  Intra=PeIvic  Branches  are: 

The  Iliolumbar,  situated  at  the  upper  part  of  the  artic- 
ulation.—  It  anastomoses  with  the  lumbars  (aorta). 

The  Obturator,  running  forward  along  the  brim  of  the 
pelvis  and  then  through  the  obturator  canal. —  It  anasto- 
moses with  the  circumflex  (femoral). 

The  Lateral  Sacral,  anastomosing  with  the  middle  sacral 
(aorta). 
The  Parietal  Extra=Pelvic  Branches  arc: 

The  Gluteal:  It  passes  out  through  the  upper  pari  of  the 
great  sacro-sciatic  notch  above  the  pyriform  muscle. 

It  is  distributed  between  the  two  layers  formed  by  the 
three  gluteal  muscles. 


158  EXTERNAL  ILIAC — FEMORAL. 

The  Ischiatic :  It  passes  out  through  the  lower  part  of  the 
great  sacro-sciatie  notch  below  the  border  of  the  pyriform 
muscle,  in  company  with  the  internal  pudic  and  the  sciatic 
nerve. 

It  is  distributed  to  the  muscles  of  the  upper  back  part  of 
the  thigh. 

It  anastomoses  with  the  Deep  Femoral. 

The  Internal  Pudic :  It  passes  out  of  the  pelvis  through 
the  lower  part  of  the  great  sciatic  notch. —  It  winds  around 
the  spine  of  the  ischium  to  penetrate  into  the  small  sacro- 
sciatic  notch. —  It  runs  along  the  ascending  branch  of  the 
ischium. 

Upon  reaching  the  root  of  the  penis  it  terminates  on  the 
back  of  the  penis  as  the  Dorsal  Artery. 
Brandies:  It  gives  rise  to  the  following: 

The  Bulbous,  to  the  bulb,  important  because  of  its  size. 

The  Cavernous,  to  the  Cavernous  Bodies. 

EXTERNAL  ILIAC. 

430  Origin  :  From  the  bifurcation  of  the  common  iliac,  opposite 
the  sacro-iliac  articulation. 

Course :  It  extends  from  the  sacro-iliac  junction  to  Pou- 
part's  ligament. — There  it  becomes  the  femoral. 
Relations .-  It  is  situated  to  the  outer  side  of  the  border 
of  the  psoas  muscle. — It  is  covered  by  the  peritoneum; — it 
is  crossed  by  the'spermatic  duct ; —  it  is  on  the  outer  side  of 
the  vein. 

431  Branches  :  They  are  the  Circumflex  Iliac  and  the  Epigastric. 
1st.  The  Circumflex  Iliac  runs  along  the  iliac  crest  and 
Poupart's  ligament. 

It  is  distributed  to  the  psoas  and  the  abdominal  muscles. 
2d.  The  Epigastric  (deep  or  ascending)  runs  along  the 
inner  side  of  the  internal  abdominal  ring  towards  the  bor- 
der of  the  abdominal  straight. 

It  penetrates  the  muscle  and  anastomoses  with  the  inter- 
nal mammary. 

FEMORAL. 

432  Origin  :   From  the  external  iliac,  at  Poupart's  ligament. 
Course  :  It  extends  from  Poupart's  ligament  to  the  opening 
in  the  great  adductor  muscle. — There  it  becomes  the  poplit- 
eal. 

Situation  or  Relations : 

Above,  it  occupies  the  middle  of  Scarpa's  triangle; — it  lies 
to  the  inner  side  of  the  sartorius,  the  psoas-iliac  and  ante- 
rior crural  nerve  ; — it  is  on  the  outer  side  of  the  vein. 

In  the  middle  of  the  thigh  it  is  covered  by  the  sartorius, — 
is  on  the  inner  side  of  the  internal  vast  muscle, — in  front 
of  the  vein. 


POPLITEAL.  1 59 

Below  the  middle  it  lies  in   Hunter's  canal, — on  the  inner 

side  of  the  vastus  interims, — on  the  outer  side  of  tin-  sarto 
rius, — in  front  of  the  vein. 

433  Branches:  They  are  the  Deep  Femoral,  Anterior  Circum- 
flex and  Great  Anastomotic. 

1st.  The    Deep    Femoral    is    really  a  bifurcation    of  the 
femoral. 

It  originates  about  one  inch  below  Poupart's  ligament. 

It  is  situated  on  the  outer  side  of  the  femoral,  between  it 
and  the  psoas-iliac  tendon. 

It  runs  down  in  the  groove  between  the  adductors  and  the 
internal  vast  muscle. 

It  gives  off  Perforating  Branches,  which  go  to  the  poste- 
rior part  of  the  thigh  and  anastomose  with  the  ischiatic. 
2d.  The  Anterior  Circumflex  often  arises  from  the  deep 
femoral. 

It  winds  around  the  posterior  part  of  the  neck  of  the 
femur. 

It  anastomoses  with  the  obturator  and  the  ischiatic. 
3d.  The  Great  Anastomotic  originates  above  the  ring  of 
the  great  adductor. 

It  descends  along  the  tendon  of  this  muscle. 

It  anastomoses  with  the  articuiars  from  the  popliteal. 

POPLITEAL. 

434  Origin  :    From  the   femoral,  at  the   ring  of   the  first  ad- 
ductor. 

Course  :  It  extends  from  the  opening  of  the  great  adductor 
to  the  arch  of  the  soleus,  where  it  divides  into  the  Anterior 
and  Posterior  Tibials. 
Situation  or  Relations : 

Above  the  joint,  it  lies  on  the  femur — to  the  outer  side  of 
the  tendon  of  semi-membranous, — to  the  inner  side  of  the 
vein  and  the  popliteal  nerve, — the  latter  being  itself  to  the 
outer  side  of  the  vein. 

Opposite  the  joint,  it  rests  on  the  posterior  ligament. — is 
covered  by  the  vein, — which  is  itself  covered  by  the  nerve. 
Below  the  joint,  it  rests  upon  the  popliteal  muscle  and  the 
tibia, —  is  on  the  outer  side  of  the  nerve  and  the  vein,  but 
considerably  overlapped  by  the  vein. 

435  Branches:  They  are  the  Articular  Arteries. 

1.  The  Superior  External  and  Internal  Articuiars. 

2.  The  Inferior  External  and  Internal   Articuiars,  which 
are  distributed  to  the  interior  of  the  joint. 

They  anastomose  with  the  great  anastomotic  of  the 
femoral. 

3d.  The  Middle  or  Azygos  Articular  is  distributed  to  the 
interior  of  the  joint. 


160  TIBIAL— DORSAL  ARTERY — PLANTAR. 


ANTERIOR  TIBIAL. 

436  Origin  :  From  the  popliteal,  at  the  arch  of  the  soleus. 
Situation  and  Course :  It  pierces  the  upper  part  of  the 
interosseous  membrane. —  It  descends  between  the  anterior 
tibial  muscle  and  the  long  extensor  of  the  great  toe  to  the 
anterior  tarsal  ligament. — There  it  becomes  the  Dorsal  of 
the  Foot. 

Branches  :  The  Recurrent  Tibial,  which  ascends  on  the  outer 
side  of  the  front  of  the  knee. 

It  anastomoses  with  the  articulars  and  great  anastomotic. 

DORSAL  ARTERY  OF  THE  FOOT. 

437  Origin  :  From  the  anterior  tibial,  at  the  anterior  tarsal  lig- 
ament. 

Situation  and  Course :  It  extends  from  the  anterior  tarsal 
ligament  to  the  posterior  extremity  of  the  first  interosseous 
space. — There  it  becomes  the  Perforating  or  Communicating, 
which  inosculates  with  the  internal  plantar  artery. 

It  is  situated  on  the  tarsal  bones. —  It  is  covered  by  the 
skin. —  Is  on  the  outer  side  of  the  tendon  of  the  extensor 
of  the  great  toe. 

Branches :  They  supply  the  tarsus,  metatarsus  and  the 
great  toe. 

POSTERIOR  TIBIAL. 

438  Origin  :  From  the  popliteal,  at  the  arch  of  the  soleus. 
Situation  and  Course :   It  extends  from  the  arch  of  the 
soleus  to  the  internal  tarsal  ligament,  where  it  divides  into 
the  internal  and  external  plantar. 

It  descends  on  the  middle  line  to  the  groove  between  the 
posterior  tibial  muscle  and  long  flexor  of  the  toes ; — lower 
down  it  inclines  to  the  inner  side  of  the  ankle, — there  it  is 
situated  between  the  tendons  of  the  long  flexor  of  the  toes 
and  the  long  flexor  of  the  great  toe,  and  is  covered  by  the 
skin  and  fascia. 

The  Posterior  Tibial  Nerve  above  is  on  the  inner  side ; — in 
the  middle  it  crosses  the  nerve, — and  below  it  is  on  its 
outer  side. 

Branches :  Only  one,  the  Peroneal,  which  descends  along 
the  fibula  and  divides  into  an  Anterior  and  a  Posterior 
Peroneals. 

EXTERNAL  PLANTAR. 

439  Origin  :  From  the  posterior  tibial,  at  the  internal  tarsal  lig- 
ament. 

Situation  and  Course :  It  is  the  continuation  of  the  pos- 
terior tibial. —  It   extends   from  the  internal  annular  liga- 


INTERNAL  PLANTAR — PECULIARITIES   OF    ARTERIES.  Hil 

ment  to   the   posterior   extremity  of  the  first  interosseous 
space. —  It  inosculates  with  the  dorsal  of  foot. 

It  is  at  first  directed  outwards  and  forwards  between  the 
short  fiexor  of  the  toes  and  the  accessory  muscle  to  reach 
the  fifth  metatarsal  bone. — There  it  turns  towards  the  pos- 
terior extremity  of  the  first  interosseous  space,  forming  the 
plantar  arch,  which  rests  on  the  posterior  extremity  of  the 
metatarsal  bones. 

Branches  :  The  Plantar  Arch,  which  supplies  the  four  outer 
toes. 

INTERNAL  PLANTAR. 

440  Origin:  From  the  posterior  tibial,  at  the  internal   tarsal 
ligament. 

Branches  :  Are  lost  in  the  muscles  of  the  internal  region  of 
the  foot. 


PECULIARITIES  OF  ARTERIES  IN  PARTICULAR. 

441  Large  Arteries  are  superficial  at  one  end  and  deep  at  the 
other. 
The  Innominate  Artery: 

Is  crossed  at  right  angle  by  the  left  Innominate  vein. 

It  is  short  and  large, — it  is  the  shortest  of  all  large 
arteries. 

It  seldom  gives  rise  to  collateral  branches. 
The  Common  Carotid  : 

It  is  crossed  by  the  sterno-mastoid. 

It  gives  rise  to  no  branches. 
The  External  Carotid  : 

Is  crossed  by  the  hypoglossal  nerve. 
The  Lingual  runs  parallel  to  the  hyoid  bone  and  to  the 
hypoglossal  nerve. 

The  Occipital  gives  rise  to  the  Descending  Cervical  (a   sur- 
gical collateral  branch). 
The  Internal  Carotid  : 

Runs  through  a  long  channel,  the  carotidean  canal. 

It  runs  also  through  a  sinus,  the  cavernous  sinus. 

It  forms  the  anterior  segment  of  the  circle  of  Willis,  a 
surgical  collateral  branch. 

It  gives  rise  to  no  branches  in  the  neck,  nor  in  the  canal 
nor  in  the  sinus. 
The  Subclavian  : 

Is  crossed  by  the  phrenic  nerve,  the  pneumo-gastric,  the 
recurrent  laryngeal,  the  thoracic  duct  on  the  Left  and  by 
the  right  lymphatic  duct  on  the  right. 

The  Left  Subclavian   is   longer  and  situated   more  deeply 
than  the  right. 

The  tubercle  of  the  anterior  scalene  is  the  guide  to  the 
subclavian  artery. 
11 


162  PECULIARITIES   OF   ARTERIES. 

It  gives  rise  to  the  Vertebral  and  to  the  Superior  Inter- 
costal, which  itself  gives  rise  to  the  Ascending  Cervical,  a 
surgical  collateral  branch. 

It  presents  the  thyroid  axis;  i.  e.,  one  short  branch 
giving  rise  to  three  arteries. 

All  its  branches  originate  from  the  first  portion. 

It  gives  rise  to  no  branches  in  the  middle  and  third  por- 
tions. 
The  Vertebral : 

Ascends  through  an  interrupted  bony  canal. 

It  winds  around  the  lateral  mass  of  the  atlas. 

The  Right  aud  the  Left  unite  to  form  the  Basilar. 

The  Branches  of  the  Basilar  form  the  posterior  segment 
of  the  circle  of  Willis. 
The  Internal  Mammary : 

Anastomoses  with  the  Epigastric,  and  it  is  the  only  direct 
anastomose  between  the  supra  and  the  infra-diaphragmatic 
circulations. 

The  Posterior  Cervical  (or  Cervical  Transverse)  crosses 
the  Subclavian  artery  and  the  branches  of  the  brachial 
plexus. 

442  The  Axillary  Artery  : 

It  is  pronged  by  the  median  nerve. 

It  gives  rise  to  the  subscapular,  a  large  surgical  collateral 
branch. 
The  Brachial  :_ 

Is  crossed  obliquely  by  the  median  nerve,  which  is  usually 
on  top  of  it. 

It  gives  rise  to  the  Superior  Profunda,  an  important  sur- 
gical collateral  branch. 

The  Radial  gives  rise  to  the  Recurrent  Radial,  the  Volar 
and  the  Deep  Palmar  Branch,  all  important  collateral  sur- 
gical branches. 

The  Ulnar  gives  rise  to  the  Recurrent  Ulnar,  the  Inter- 
osseous, the  branch  of  the  Superficial  Palmar  Arch,  all  im- 
portant surgical  collateral  branches. 

443  The  Arch  of  the  Aorta : 

It  is  the  only  arch  of  the  kind  except  azygos  vein  and 
thoracic  duct. 

It  is  crossed  obliquely  by  the  Innominate  Vein. 

It  is  wound  around  by  the  Pulmonary  Artery. 

It  is  also  wound  around  by  the  Left  Recurrent  Laryngeal 
Nerve. 

The  Thoracic  Aorta  is  crossed  obliquely  by  the  oesophagus. 
The  Abdominal  Aorta  and  Branches  will  be  studied  with 
the  arteries  of  the  organs. 
The  Common  Iliac  gives  rise  to  no  branches. 
The  Internal  Iliac: 

Is  crossed  by  the  ureter  at  its  origin. 


PECULIARITIES  OF  THE  ARTERIES  OF  THE  ORGANS.  163 

It  gives  rise  to  the  Ischiatic,  a  most  important  surgical 
collateral  branch. 
The  External  Iliac: 

Gives  rise  to  no  branches  until  near  its  termination. 

Then  it  gives  rise  to  the  Epigastric,  an  important  surgical 
collateral  branch. 

It  is  crossed  by  the  ureter  and  the  spermatic  duct. 
The  Femoral : 

Is  crossed  obliquely  by  the  Sartorius. 

A   portion   is   contained   in   a   fibrous  canal, —  Hunter's 
Canal. 

It  gives  rise  to  the  Profunda  and  the  Great  Anastomotic, 
two  important  surgical  collateral  branches. 
The  Popliteal: 

Is  deeply  seated. 

It  is  crossed  oblicpiely  by  the  vein  and  the  nerve. 

It  gives  rise  to  the  articulars,  important  surgical  collat- 
eral branches. 
The  Anterior  Tibial : 

Gives  rise  to  the  Recurrent  Tibial,  a  surgical  collateral 
branch. 

It  gives  rise  also  to  the  Dorsal,  which  inosculates  with  the 
External  Plantar. 

The  Posterior  Tibial  gives  rise  to  the  Peroneal,  a  surgical 
collateral  branch. 

It  gives  rise  also  to  the  External  Plantar,   which  forms 
the  Plantar  Arch  and  inosculates  with  the  Dorsal. 


PECULIARITIES    OF   THE  ARTERIES   OF   THE   ORGANS. 

ORGANS  OF  DIGESTION. 
444  Lips: 

The  Coronary  Arteries  reach  the  lips  at  the  commissure. 

They  are  between  the  muscular  and  mucous  layers  in  the 
glandular  layer. 
teeth  : 

The  Inferior  Dental  Artery  runs  through  a  bony  canal. 
Tongue : 

The  Ranine  arteries  are  dangerously  large  beyond  the  an- 
terior half. 
Tonsils : 

The   Tonsillar  branch   is  large,   and  is  adherent  to  the 
tissue  in  chronic  tonsillitis  ;  hence  hemorrhage. 

The  Internal  Carotid  is  close  to  its  external  surface. 
Parotid  Gland  : 

The  External  Carotid  divides  in  its  substance  behind  the 
condyle. 


164  ORGANS    OP  URINATION — ORGANS   OP   GENERATION. 

Submaxillary  Gland : 

The  facial  artery  crosses  its  posterior  extremity. 
Pharynx : 

The  Internal  Carotid  is  in  relation  with  the  lateral  walls. 
(Esophagus : 

It  is  crossed  obliqnely  by  the  aorta. 
Stomach : 

It  is  surrounded  by  an  arterial  circle. 
Small  Intestines : 

They   are   supplied   by   one   artery   alone,  the   Superior 
Mesenteric. 
Large  Intestines : 

The  right  half  is  supplied  by  the  Superior  Mesenteric. 

The  left  half  by  the  Inferior  Mesenteric,  which  terminates 
by  the  Superior  Hemorrhoidal  to  the  rectum. 
Rectum  : 

Is  supplied  by  the  Three  Hemorrhoidals. 

The   Superior  Hemorrhoidals  are  the  largest  and   most 
dangerous. 
Anus : 

Is  supplied   by  the   Inferior   Hemorrhoidals,  which  are 
small. 
Liver: 

The  Hepatic  Artery  is  remarkable  for  its  small  size. 
Spleen  : 

The  Splenic  Artery  is  remarkable  for  its  large  size. 

ORGANS  OF  URINATION. 

445  Kidneys  :  The  Renal  Arteries  are  remarkable  for  their  large 
size. 

The  right  is  lower  than  the  left. 

They  are  in  front  of  the  calices  and  pelvis,  and  behind  the 
veins. 

They  form  a  Capillary  Arterial  Portal  System. 

They  carry  darker  blood  than  the  veins. 
Bladder: 

It  is  well  provided  with  arteries  ;  three  branches  on  each 
side.  ' 

ORGANS  OF  GENERATION. 
Testicles : 

The  Spermatic  Arteries  are  long  and  slender. 
Spermatic  Duct: 

The  Spermatic  Artery  is  closely  attached  to  it. 
Penis : 

It  has  two  Dorsal  Arteries. 

They  terminate  by  dilated  extremities. 


THE  HEART — ORGANS  OP  RESPIRATION,  SPECIAL  SENSE.        105 

THE  HEART. 


44G  Has  Two  Coronary  Arteries. 

They  originate  below  the  Sigmoid  valves. 
They  fill  up  during  ventricular  diastole  and   by  arterial 
systole. 

ORGANS  OF  RESPIRATION. 
Lungs : 

The  Bronchial  Arteries: 
Are  remarkably  small. 
They  are  the  nutrient  arteries. 
The  Pulmonary  Artery: 
Is  remarkably  large  for  the  organs. 
It  contains  dark  blood. 
It  terminates  by  three  capillary  plexuses. 
Thyroid  Body : 

It  is  remarkably  vascular  for  its  size. 
It  has  five  Thyroid  Arteries. 

CENTRAL  ORGANS  OF  INNERVATION. 

Cerebral  Dura  Mater: 

It  presents  the  Middle  Meningeal  Artery. 
Cerebral  Pia  Hater  : 

It  is  remarkably  vascular. 
Cerebrum : 

The  arteries  form  the  circle  of  Willis. 

No  large  arteries  penetrate  its  substance. 
Cerebellum  : 

It  is  not  as  well  supplied  with  arteries  as  the  cerebrum. 
Spinal  Cord : 

It  presents  the  two   long  anterior  and  posterior  Spinal 
Arteries. 

ORGANS  OF  SPECIAL  SENSE. 

447  Choroid: 

It  is  provided  with  numerous  arteries. 
Retina  : 

It  presents  the  Central  Artery  of  the  Retina,   which  is 
unique  in  its  course  in  the  optic  nerve. 

The  terminal  divisions  of  this  artery  are  remarkable. 
Iris: 

It  is  remarkably  vascular. 

It  receives  the  arteries  from  two  sources :  the  Posterior 
Long  Ciliary  and  the  Anterior  Short  Ciliaries. 

ORGANS  OF  HEARING. 

Nothing  special. 


166  ORGANS   OF  LOCOMOTION — DIRECTION   OP  ARTERIES. 

ORGANS  OF  LOCOMOTION. 

Bones  : 

The  Long  Bones  specially  possess  a  Nutrient  Artery. 

The  Petrous  Bone  is  traversed  by  the  Internal  Carotid. 

The  Inferior  Maxilla  is  traversed  by  the  Inferior  Dental 
Artery. 
Articulations  : 

Many  of  these   are   surrounded    by   Arterial    Articular 
Circles. 
Muscles: 

The  Internal  Pterygoid  is  traversed  by  the  Internal  Max- 
illary. 

ORGANS  OF  CIRCULATION. 

Arteries : 

The  Arteries  of  Arteries  come  from  neighboring  branches 
and  from  the  trunk  itself. 
Veins  : 

Arteries  of  Veins  come  from  neighboring  branches. 

LINES  INDICATING  THE  DIRECTION  OF  THE  MAIN 
ARTERIES  AND  MUSCLES  WHICH  ARE  GUIDES 
TO  ARTERIES. 

448  1st.  Innominate.  Line  from  the  middle  of  the  sternal 
junction  to  the  sternal  tendon  of  the  sterno-mastoid. 

2d.  Common,  External  and  Internal  Carotids.  Line 
from  sterno -clavicular  articulation  to  space  between  mastoid 
process  and  angle  of  lower  jaw.  Guide:  the  sternocleido- 
mastoid muscle. 

Bifurcation  of  Common  Carotid.  Opposite  upper  border 
of  thyroid  cartilage. 

3d.  Lingual.  Line  parallel  to  great  horn  of  hyoid  bone, 
one-third  inch  above  it.  Guide:  hyoglossus  muscle  and 
hypoglossal  nerve. 

4th.  Facial.  1st.  Line  from  great  horn  of  thyroid  carti- 
lage to  anterior  inferior  angle  of  masseter. — 2d.  Line  from 
anterior  inferior  angle  of  masseter  to  angle  of  lip. — 3d. 
Line  from  angle  of  lip  to  groove  of  wing  of  nose. — 4th. 
Line  from  groove  of  nose  to  angle  of  eye. 
5th.  Internal  Maxillary.  Immediately  behind  the  condyle 
of  the  jaw. 

449  6th.  Subclavian  Artery.  Line  corresponding  to  the 
middle  of  space  between  posterior  border  of  sterno-mastoid 
and  anterior  border  of  trapezius.  Guide:  anterior  scalene 
and  its  tubercle  on  the  first  rib. 

7th.  Axillary  (1st  portion)  Infra-clavicular  region.  Line 
below  anterior  convexity  of  clavicle.  Guide:  small  pectoral 
and  the  axillary  vein. 


DIRECTION   OF  ARTERIES.  167 

8th.  Axillary  in  Axillary  Space.  Liiie  from  apex  of  axilla 
to  middle  of  space  between  tendons  of  great  pectoral  and 
great  dorsal.  Guide;  coraco-brachial  and  the  two  heads  of 
the  median  nerve. 

9th.  Subscapular  Artery.  Inner  part  and  lower  end  of 
glenoid  cavity.  Guide:  tendon  of  the  great  dorsal. 
10th.  Brachial.  Line  from  pit  of  axilla  to  middle  of  bend 
of  elbow.  Guide:  above,  coraco-brachial;  in  middle, 
biceps  and  median  nerve;  below,  tendon  of  biceps  and 
median  nerve. 

11th.  Radial  in  Forearm.  Line  from  middle  of  bend  of 
elbow  to  styloid  process.  Guide:  the  long  supinator. 
12th.  Radial  Along  Outer  Border  of  Wrist.  Line  from 
tubercle  of  supinator  to  upper  extremity  of  first  interros- 
seous  space.  Guide:  tendons  of  extensors  of  metacarpal 
bone  and  phalanges  of  thumb,  which  it  crosses  diagonally. 
13th.  Ulnar.  Line  from  middle  of  bend  of  elbow  to  inner 
side  of  pisiform  bone.  Guide:  ulno-earpal  flexor. 
11th.  Superficial  Palmar  Arch.  Line  of  the  thumb  sepa- 
rated widely  from  the  fingers. 

15th.  Deep  Palmar  Arch.  Same  line,  but  half  an  inch 
nearer  the  wrist. 

16th.  Internal  Mammary.  About  one-quarter  inch  to 
outer  side  of  border  of  sternum. 

17th.  Epigastric.  Line  from  middle  of  Poupart's  liga- 
ment to  umbilicus. 

18th.  Common  and  External  Iliac.  Line  from  right  of 
middle  of  Poupart's  ligament  to  two  inches  below  the  um- 
bilicus.    Guide:  psoas  muscle. 

19th.  Gluteal  Artery  (point  of  emergence  at  buttock). 
Junction  of  middle  with  inner  third  of  a  line  from  the  pos- 
terior superior  spine  of  ilium  to  great  trochanter  rotated 
inward. 

20th.  Internal  Pudic.  Junction  of  lower  and  middle  third 
of  a  line  from  outer  side  of  tuberosity  of  ischium  to  poste- 
rior superior  spine  of  pubis. 

21st.  Ischiatic.  Same  place,  but  nearer  the  middle  of  the 
line. 

22d.   Bulbous  Artery   (from    Internal  Pudic).     Horizontal 
line  midway  between  anus  and  root  of  scrotum. 
23d.   Femoral    Artery.     Line   from   middle  of    Poupart's 
ligament  to  tubercle  of  great  adductor  (upper  two-thirds). 
Guide:   sartorius  muscle. 

21th.  Popliteal.  Line,  axis  or  middle  of  the  hams  of  the 
space.  Guide:  semi-membranous  muscle,  the  vein  and  the 
nerve. 

25th.  Anterior  Tibial.     Line  from  head  of  fibula  to  middle 
of  intermalleolar  space.      Guide:   anterior  tibial  muscle. 
26th.   Dorsal  Artery.     Line  from  middle  of  intermalleolar 


168  CIRCULATORY   CIRCUITS. 

space  to  first  interosseous  space.  Guide:  tendon  of  long 
extensor  of  great  toe  (artery  on  outer  side). 
27th.  Posterior  Tibial.  Line  from  middle  of  popliteal 
space  to  middle  of  space  between  internal  malleolus  and 
calcaneum.  Guide  :  tendon  of  the  posterior  tibial  muscle. 
28th.  Peroneal  Artery.  Line  from  middle  of  popliteal 
space  to  posterior  border  of  external  malleolus.  Guide: 
long  flexor  of  great  toe. 

29th.  Plantar  Arch.  Line  from  posterior  extremity  of 
fifth  metatarsal  bone  to  posterior  extremity  of  first  meta- 
tarsal. 

CIRCULATORY  CIRCUITS. 

454  There  are  three  different  and  independent  circulatory  cir- 
cuits :  the  Cardiac,  the  Pulmonary  and  the  General  or  Sys- 
temic. 

The  Cardiac  Circuit  corresponds  to  the  two  Cardiac  Arte- 
ries, to  the  Great  Cardiac  Vein  and  to  the  Veins  of  The- 
besius. 

The  Pulmonary  Circuit  comprises  the  Bronchial  Circula- 
tion and  the  Pulmonary  Circulation. 

The  Bronchial  Circuit  corresponds  to  the  Two  Bronchial 
Arteries  and  to  the  Bronchial  Veins. 

The  Pulmonary  Circuit    Proper,  corresponds  to  the  Pul- 
monary Artery  and  to  the  Four  Pulmonary  Veins. 
The  General  or  Systemic  Circuit  comprises  the  Supra- 
Diaphragmatic  and  the  Infra-Diaphragmatic  circulations. 

These  Two  Circuits  communicate  together  through  the 
anastomose  of  the  Internal  Mammary  with  the  Epigastric 
in  front,  and  behind  by  the  anastomose  of  the  Lower  Inter- 
costals  with  the  Lumbar  Arteries.  The  Venous  communi- 
cations are  through  the  veins  accompanying  the  arteries  and 
through  the  anastamoses  of  the  origin  of  the  azygos  with 
the  lumbar  veins. 

The  Supra=Diaphragmatic  Circuit  corresponds  to  the 
Arch  and  its  Branches  and  to  the  Superior  Cava  Vein  and 
its  Branches. 

It  presents  a  Cephalic  and  a  Brachial  Circuit. 
The  Cephalic  Circuit  corresponds  to  the  Branches  of  the 
Carotids  and  the  Jugular  Veins. 

The  Cephalic  Circuit  is  subdivided  into  the  Exterior  and 
the  Interior  Circuits. 

The  Exterior  Circuit  corresponds  to  the  External  Carotid, 
the  Facial  and  Temporal  Arteries,  and  to  the  External  Jugu- 
lar Vein. 

The  Interior  Circuit  corresponds  to  the  Internal  Carotid 
and  to  the  Internal  Jugular  Vein. 

The  Brachial  Circuit  or  Circuit  of  the  Upper  Extremity 
corresponds  to  the  Subclavian,  Axillary,  Brachial,  Radial 


ARTICULAR    ARTERJAL   CIRCLES.  109 

Ulnar  Arteries  and  to  the  Veins  of  the  same  name  joining 
into  the  Innominate  Vein. 

455  The  Infra=Diaphragmatic  Circuit  corresponds  to  the  Tho- 
racic and  Abdominal  Aorta,  and  to  the  Inferior  Cava  Vein. 

It  comprises  the  following  peculiar  circuits  : 

The  Portal-Hepatic  Circuit,  which  corresponds  to  the  Cceliac 
Axis  of  the  Two  Mesenteric  arteries  and  to  the  Formative 
Branches  of  the  Portal  Vein  and  to  the  Hepatic  Veins. 

The  Renal  Circuit  is  formed  by  the  Renal  Arteries  and 
Veins. —  It  presents  the  peculiar  Arterial  Portal  System  of 
the  Malpighian  Corpuscles. 

The  Penile  Circuit  corresponds  to  the  Two  Dorsal  Arteries 
and  to  the  Single  Dorsal  Vein. 

The  Circuits  in  the  Pregnant  Uterus  present  three  divi- 
sions.— The  Circulation  of  the  Uterine  Walls  corresponds  to 
the  Ovarian  and  Uterine  Arteries  and  their  Veins. — The  Cir- 
culation of  the  Embryo  or  of  the  Umbilical  Vesicle  and  — 
The  Circulation  of  the  Foetus  or  Placental  Circulation,  pre- 
sents the  peculiar  Venous  Hepatic  Branch,  the  Oval  For- 
amen and  the  Arterial  Aortic  Duct. 

The  Circuit  of  the  Pelvis  corresponds  to  the  Internal  Iliac 
and  its  Veins. 

The  Circuit  of  the  Lower  Extremity  corresponds  to  the 
Iliacs  and  Divisions  and  of  their  Veins. 

ARTICULAR  ARTERIAL  CIRCLES. 

456  Each  large  articulation  is  surrounded  by  a  circle  of  arteries 
which  are  the  collateral  channels  by  which  the  circulation 
is  re-established  when  the  main  trunks  are  ligated.  Thus  : 
Neck  and  Trunk.     Anastomoses  of : 

Superior  Thyroid  with  Inferior  Thyroid. 

Occipital  and  its  Descending  Cervical  Branch  with  the 
Superior  Intercostal  and  its  Ascending  Cervical  Branch. 

The  Vertebral  with  the  Internal  Carotid  through  the 
circle  of  Willis. 

The  Nasal  of  Ophthalmic  with  the  Nasal  of  the  facial. 
Arm  and  Trunk.     Anastomoses  of: 

Scapulars  of  Subclavian  with  Subscapular  and  Circum- 
flex of  the  Axillary  aud  Ascending  of  Profunda  of  Bra- 
chial. 

Subscapular,  Long  Thoracic ,  Circumflex,  Beep.  Brachial  and 
Scapulars  of  Subclavian  with  Perforating  Aortic  Inter- 
costals. 

Elbow :  Anastomoses  between  the  two  Profunda?  and  the 
Anastomotic  of    the  Brachial  with  the  Recurrent  Radial, 
Recurrent  Ulnar,  Recurrent  Interosseous. 
Wrist  and  Hand  : 

Anastomoses  through  the  Palmar  Arches. 

Anastomoses  of  the  Interosseous  and  the  Carpals. 


170  IMPORTANT  BRANCHES   OP  ARTERIES. 

Anastomose  between  the  Supra=diaphragmatic  and  the 
Infra=diaphragmatic  Arteries  through  the  anastomoses  of : 

Internal  Mammary  and  Epigastric. 

Intercostals  and  Epigastric. 

Lumbar  Arteries  with  the  last  Intercostals. 
Trunk  and  Thigh.     Anastomoses  of : 

Ischiatic  with  Profunda. 

Circumflex  Iliac  with  the  Lumbar  Arteries. 

Circumflex   and   Obturator  with  Epigastric  and  Internal 
Mammary. 
Knee  Joint.     Anastomoses  of : 

The  four  Articulars  with  the  great  Anastomotic  and  with 
Recurrent  Tibial. 
Ankle  and  Foot.     Anastomoses  of  the — 

Dorsal  with  the  External  Plantar. 

Dorsal  with  the  Peroneal. 

Anterior  Tibial  with  the  Peroneal. 

ENUMERATION  OF  THE  MOST  IMPORTANT  BRANCHES 
OF  ARTERIES  NECESSARY  TO  UNDERSTAND  THE 
ESTABLISHMENT  OF  THE  COLLATERAL  CIRCULA- 
TION AFTER  THE  LIGATURE  OF  ARTERIES. 

457  External  Carotid: — Superior  Thyroid, — Lingual, —  Facial, 

—  Occipital,  giving  rise  to  Descending  Cervical, —  Internal 
Maxillary, — Temporal. 

Internal  Carotid  : 

Nasal,  the  terminal  branch  of  the  Ophthalmic. 

Anterior  Cerebral,  giving  rise  to  the  Anterior   Communi- 
cating. 

Middle  Cerebral,  giving  rise  to  the  Posterior  Communi- 
cating. 
Subclavian  Artery: 

Vertebral,  forming  the  Basilar,   which  divides  into  the 
Posterior  Cerebrals. 

Inferior  Thyroid. 

Superior  Intercostal,  giving  rise  to  the  Ascending  Cervical. 

Internal  Mammary. 

Anterior  Scapular  (or  Supra-scapular). 

Posterior  Scapular  (or  Transverse  Cervical). 
Axillary: — Long  Thoracic, —  Subscapular, — Posterior  Cir- 
cumflex. 

Brachial :  —  Superior     Deep     Brachial,  —  Inferior     Deep 
Brachial, —  Great  Anastomotic. 
Radial : — Recurrent  Radial, —  Palmar  or  Volar, —  Carpals, 

—  Metacarpals, — Deep  Palmar  Arch. 

Ulnar: — Anterior  Ulnar, — Posterior  Ulnar, —  Anterior  In- 
terosseous,—  Posterior  Interosseous, —  Recurrent  Interos- 
seous,—  Carpals, —  Metacarpals, — Branch  to  Deep  Palmar 
Arch, — Superficial  Palmar  Arch. 


SURGICAL  COLLATERAL  BRANCH  OF  ARTERIES.  171 

458  Thoracic  Aorta  : — Intercostal s. 
Abdominal  Aorta  : — Lumbar*. 
Internal  Iliac. 

Visceral  Branches: — Vesical, — Uterine, — Vaginal. 

Parietal  Intra-pelvic:  — Ilio-lumbar,  —  Lateral  Sacral, — 
Obturator. 

Parietal  Extra-pelvic :  —  Gluteal,  —  Ischiatic,  —  Internal 
Pudic. 

External  Iliac: — Epigastric, — Circumflex  Iliac. 
Femoral: — Deep  Femoral,  giving   rise  to   Perforating, — 
Anterior  Circumflex, — Great  Anastomotic. 
Popliteal : — Superior  Articulars,  Internal  and  External. — 
Middle   Articulars, — Inferior  Articulars,  Internal  and  Ex- 
ternal. 

Anterior  Tibial : — Recurrent  Tibial. 

Dorsal  of  the  Foot,  terminating  into  the  Perforating  and 
Communicating. 
Posterior  Tibial : 

Peroneal,  giving  rise  to  Anterior  and  Posterior  Peroneals. 
External  Plantar  forming  the  Plantar  Arch,  inosculating 
with  the  Perforating. 

SURGICAL  COLLATERAL  BRANCH  OP  THE 
MAIN  ARTERIES. 

459  It  is  the  branch  which  is  commonly  the  great  anastomotic 
medium  by  which  the  blood  is  carried  to  the  parts  beyond 
the  ligated  trunk. 

In  some  situations  we  find  also  a  smaller  accessory  eollatera-l 
surgical  branch. 

The  Common  Carotid  and  the  Internal  Carotid  form 
really  but  one  artery,  and  its  surgical  collateral  branch  is 
the  External  Carotid. 

The  Surgical  Collateral  branch  of  the  External  Carotid 
is  the  Occipital  Artery,  on  account  of  its  Descending  Cer- 
vical branch  which  anastomoses  with  the  Ascending  Cervi- 
cal branch  of  the  Superior  Intercostal  from  the  Subclavian. 

The  Surgical  Collateral  Branches  of  the  Internal  Carotid 
are  the  Anterior  and  Posterior  Communicatins:  of  the  circle 
of  Willis. 

The  Surgical  Collateral  Branch  of  the  Subclavian  is  the 
Vertebral,  because  of  its  free  anastomoses  with  the  circle 
of  Willis. 

The  Accessory  Branch  is  the  Ascending  Cervical  from  the 
Superior  Intercostal,  on  account  of  its  anastomoses  with 
the  Descending  Cervical  from  the  Occipital  of  the  External 
Carotid. 

The  Surgical  Collateral  Branch  of  the  Axillary  is  the 
Subscapular. —  The  Accessory  Branch  is  the  Posterior  Cir- 
cumflex. 


172  COLLATERAL  CIRCULATION  AFTER  LIGATURE. 

The  Surgical  Collateral  Branch  of  the  Brachial  is  the 
Superior  Deep  Brachial. —  The  Accessory  Branch  is  the  Great 
Anastomotic. 

The  Surgical  Collateral  Branch  of  the  Radial  is  the  Re- 
current Radial. — The  Accessory  Branches  are  the  Volar  and 
the  Superficial  Palmar  Arch. 

The  Surgical  Collateral  Branches  of  the  Ulnar  are  the  In- 
terosseous, Anterior  and  Posterior,  because  of  the  anastomo- 
ses through  the  Recurrent  Ulnar  with  the  Deep  Brachial  and 
below  with  the  Carpal  Arteries  from  the  Radial  and  Ulnar. 

The  Accessory  Branch  of   the  Ulnar  is  the  Deep  anas- 
tomotic branch  to  the  Deep  Palmar  Arch. 
460  The  Surgical  Collateral  Branches  of  the  Thoracic  Aorta 
are  the  Intercostal  Arteries,  because  of  the  anastomoses 
with  the  Subscapular. 

The  Surgical  Collateral  Branches  of  the  Abdominal  Aorta 
are  the  Lumbar,  which  anastomose  with  the  Ilio-lumbar. 
The  Common  and  the  External  Iliacs  form  really  but  one 
artery,  and  the  Surgical  Collateral  Branch  is  the  Internal 
Iliac. —  The  Accessory  Branch  is  the  Ischiatic. 

The  Surgical  Collateral  Branch  of  the  External  Iliac  is 
the  Epigastric. — The  Accessory  Branch  is  the  Circumflex 
Iliac. 

The  Surgical  Collateral  Branch  of  the  Femoral  is  the 
Deep  Femoral,  on  account  of  its  anastomoses  above  with 
the  Ischiatic  from  the  Internal  Iliac  and  below  with  the 
Articulars  from  the  Popliteal. —  It  is  the  typical  surgical 
collateral  branch. —  The  Accessory  Branch  is  the  Great  Anas- 
tomotic. 

The  Surgical  Collateral  Branch  of  the  Popliteal  is  the 
Anterior  Tibial,  because  it  anastomoses  above  with  the  Ar- 
ticulars and  Great  Anastomotic  and  below  through  the  Per- 
forating Artery  with  the  External  Plantar,  Posterior  Tibial 
and  the  Anterior  Peroneal. 

The  Surgical  Collateral  Branch  of  the  Posterior  Tibial 
is  the  Peroneal,  because  it  anastomoses  through  its  anterior 
terminal  branch  with  the  Tarsal  arteries  from  the  Dorsal 
and  the  Anterior  Tibial. 

COLLATERAL    CIRCULATION    AFTER   LIGATURE  (i.  e., 

HOW   THE   PARTS   BEYOND  THE  LIGATURE   ARE   SUPPLIED). 

461  Guide.  Name  in  order  each  important  branch  originating 
from  the  ligated  artery  (above  or  below  the  point  of  liga- 
ture), and  say  with  what  artery  it  anastomoses. 
Collateral  Circulation  After  Ligature  of  the  Innominate. 

Anastomoses  of  the  branches  of  the  External  Carotid 
with  their  fellow  of  the  opposite  side. 

Anastomoses  of  the  Two  Internal  Carotids  in  the  Circle  of 


COLLATERAL   CIRCULATION    AFTER   LIGATURE.  173 

Willis  through  the  Anterior  Communicating  of  the  Anterior 
Cerebrals. 

Anastomoses  of  the  Two  Vertebrals  in  the  Circle  of 
Willis  through  the  Two  Posterior  Cerebrals  of  the  Basilar. 

Anastomoses  of  Descending  Cervical  from  Occipital  with 
the  Ascending  Cervical  of  the  Superior  Intercostal  (sub- 
clavian). 

Anastomoses  of  Long  Thoracic  and  Subscapular  of  axillary 
with  Perforating  Aortic  Intercostals. 

Collateral   Circulation   After    Ligature  of  the  Common 
Carotid. 

Anastomoses  of  External  Carotid  with  its  fellow. 

Anastomoses  of  Descending  Cervical  (external  carotid) 
with  the  Ascending  Cervical  (superior  intercostal  of  sub- 
clavian). 

Anastomoses  of  Internal  Carotid  with  its  fellow  in  the 
circle  of  Willis  through  the  Anterior  Communicating. 

Anastomoses  of  Internal  Carotid  with  the  Vertebral  in  the 
circle  of  Willis  through  the  Posterior  Communicating. 
Collateral   Circulation  After  Ligature  of  the   External 
Carotid. 

Anastomoses  of  its  Branches  with  their  fellows. 

Anastomoses  of  Facial  with  Nasal  (ophthalmic). 

Anastomoses  of  Descending   Cervical  (occipital)  with  As- 
cending Cervical  (superior  intercostal  subclavian). 
Collateral  Circulation  After  the  Ligature  of  the  Inter- 
nal  Carotid. 

Anastomoses  of  Nasal  (ophthalmic)  with  Facial  (exter- 
nal carotid). 

Anastomoses  with  its  Fellow  in  the  circle  of  Willis 
through  the  Anterior  Cerebral. 

Anastomoses  of  the  Posterior  Cerebral  with  the  Vertebral 
in  the  circle  of  Willis. 
462  Collateral   Circulation  After  the  Ligature  of  the  First 
Portion  of  the  Subclavian,  i.  e.,  inside  the  origin  of  all 
its  branches. 

Anastomoses  of  Vertebral  with  its  fellow  in  the  circle  of 
Willis  through  the  Basilar. 

Anastomoses  of  the  Inferior  Thyroid  with  the  other  Thy- 
roids in  the  Thyroid  Body. 

Anastomoses  of  the  Superior  Intercostal  through  the  As- 
cending Cervical  with  the  Descending  Cervical  of  the  Occip- 
ital (external  carotid). 

Anastomoses  of  the  Internal  Mammary  with  the  Epigastric 
(external  iliac). 

Anastomoses  of  the  Anterior  Scapular  with  Subscapular 
(axillary). 

Anastomoses  of  the  Subscapular  and  Long  Thoracic  (axil- 
lary) with  Perforating  Intercostal  (aorta). 
Collateral  Circulation  After  the  Ligature  of  Second,    or 


174  COLLATERAL   CIRCULATION   AFTER   LIGATURE. 

Third  Portions  of  the  Subclavian,  i.  e.,  outside  the  ori- 
gin of  all  its  branches  ;  and 

Collateral  Circulation  After  the  Ligature  of  the  First 
Portion  of  the  Axillary,  i.  e.,  above  the  Small  Pectoral, 
i.  e.,  above  the  origin  of  the  Long  Thoracic  (axillary). 

These  three  ligatures  are  practically  all  the  same  as  re- 
gards the  collateral  circulation. 

Anastomose  of  the  Scapulars  (subclavian)  with  the  Sub- 
scapular (Axillary). 

Anastomose  of  the  Long  Thoracic  with  Perforating  Inter- 
costals. 

Anastomose  of  Subscapular  with  Perforating  Intercostals. 

Anastomose  of  Circumflex  with  the  Two  Scapulars  of  the 
Subclavian . 

Collateral  Circulation  After  the  Ligature  of  the  Axillary 
in  its  Third  Portion,  i.  e.,  below  the  origin  of  the  Sub- 
scapular, and 

463  Collateral    Circulation  After   Ligature  of  the   Brachial 
Above  the  Origin  of  the  Superior  Deep  Brachial. 

These  two  ligatures  are  practically  the  same. 

Anastomose  of  the  Subscapular  (axillary)  with  the  As- 
cending Branch  of  the  Superior  Deep  Brachial. 

Anastomose  of  the  Circumflex  (axillary)  with  same. 
Collateral  Circulation    After  Ligature   of  the  Brachial 
Below  the  Superior  Deep  Brachial,  but  Above  the  Infe= 
rior  Deep  Brachial. 

Anastomoses  of  the  Superior  Beep  Brachial  with  Recurrent 
Radial  and  the  Elbow  Circle. 

Collateral  Circulation  After  Ligature  of  the  Brachial 
at  the  Bend  of  the  Elbow,  i.  e.,  below  the  origin  of  all  its 
branches. 

Anastomose  of  the  Superior  Beep  Brachial  with  Recurrents 
and  Elbow  Circle. 

Anastomoses  of  the  Inferior  Beep  Brachial  with  same. 

Anastomoses  of  the  Great  Anastomotic  with  same. 
Collateral  Circulation  After  the  Ligature  of  the  Radial 
Alone. 

Anastomoses  through  the  Two  Palmar  Arches. 
Collateral  Circulation  After  the  Ligature  of  the  Ulnar 
Alone. 

Anastomoses  through  the  Two  Palmar  Arches. 
Collateral  Circulation  After  the  Ligature  of  the  Radial 
and  Ulnar  Simultaneously. 

Anastomoses   of  the  Interosseous   with  the  Carpals  and 
Metacarpal  Arteries  (from radial  and  from  ulnar). 

464  Collateral  Circulation  After  the  Ligature  of  the  Com= 
mon  Iliac. 

Anastomoses  through  Branches  of  Internal  Iliac. 
Anastomose  of  Ilio-lumbar  (internal  iliac)  with  Lumbars 
(aorta). 


COLLATERAL  CIRCULATION   AFTER    LIGATURE.  17.") 

Anastomoses  of  Visceral  Branches  of  internal  iliac  with 
their  fellows. 

Anastomose  of  Lateral 'Sac ral  (internal  iliac)  with  Middle 
Sacral  (aorta). 

Anastomoses  through  Brandies  of  the  External  Iliac. 

Anastomose  of  Fj>i(/astric  (external  iliac)  with  Internal 
Mammary  (subclavian) . 

Anastomose  of  Circumflex  Iliac  (external  iliac)  with  Lum- 
bars  (aorta). 

Collateral  Circulation  After  the  Ligature  of  the  Inter= 
nal  Iliac. 

Anastomoses  of  Vesical  Brandies  (internal  iliac  with  their 
fellows). 

Anastomose  of  Ilio-lumbar  (internal  iliac)  with  Lumbars 
(aorta). 

Anastomose  of  Obturator  (internal  iliac)  with  Circumflex 
(femoral). 

Anastomose  of  Lateral  Sacral  (internal  iliac)  with  Middle 
Sacral  (aorta). 

Anastomose  of  Ischiatic  (internal  iliac)  with  Deep  Fem- 
oral. 

Collateral  Circulation  After  Ligature  of  the  External 
Iliac. 

Anastomose  of  Epigastric  with  Internal  Mammary  (sub- 
clavian). 

Anastomose  of  Circumflex  Iliac  with  Lumbars  (aorta). 

Anastomose  of  Circumflex  (femoral)  with  Obturator  (in- 
ternal iliac). 

Anastomose   of    Deep   Femoral  w/th    Ischiatic    (internal 
iliac). 
465  Collateral  Circulation    After   Ligature  of  the  Common 
Femoral. 

Anastomose  of  Beep  Femoral  with  Ischiatic  (internal 
iliac). 

Anastomose  of  Circumflex  (femoral)  with  Obturator  (in- 
ternal iliac). 

Collateral  Circulation  After  the  Ligature  of  the  5uper= 
ficial  Femoral  Above  the  Origin  of  the  Great  Anas= 
tomotic. 

Anastomoses  of  Beep  Femoral  with  Articidars  (popliteal). 
Collateral  Circulation  After  the  Ligature  of  the  Pop= 
liteal  Above  the  Posterior  Ligament. 

Anastomoses  of  Great  Anastomotic  (femoral)  with  Re- 
current Tibial  and  the  Inferior  Articnlars. 

Anastomoses  of  Superior  Artieulars  (popliteal)  with  the 
Inferior  Articnlars  (popliteal). 

Collateral  Circulation  After  the  Ligature  of  the  Pop= 
liteal  Below  the  Posterior  Ligament. 

Anastomose  of  the  Great  Anastomotic  (femoral)  with 
Recurrent  Tibial  (anterior  tibial). 


176  VEINS   OF   SYSTEMIC    CIRCULATION. 

Anastomose  of  all  the  Articulars  (popliteal)  with  Recur- 
rent Tibial. 

Collateral  Circulation   After   the    Ligature  of  the  An= 
terior  Tibial. 

Anastomose    of    Dorsal   Artery  with   External   Plantar 
(posterior  tibial). 

Collateral  Circulation  After  the    Ligature  of  the  Pos= 
terior  Tibial. 

Anastomoses  of  External  Plantar  with  Dorsal  Artery  (an- 
terior tibial). 

Collateral    Circulation  After  the  Ligature  of  the  Per= 
oneal. 

Anastomoses  of  Dorsal  Artery  (anterior  tibial)  with  An- 
terior and  Posterior  Peroneals. 

Collateral  Circulation  After  Simultaneous  Ligature  of 
the  Anterior  and  Posterior  Tibials. 

Anastomoses  of  Dorsal  Artery  (anterior  tibial)  with  Ante- 
rior and  Posterior  Peroneals. 

Anastomoses  of  External  Plantar  (posterior  tibial)  with 
Dorsal  Artery  and  the  Anterior  and  Posterior  Peroneals. 
Collateral  Circulation  After  the  Simultaneous  Ligature 
of  the  Anterior  Tibial,   Posterior  Tibial  and    Peroneal. 

Anastomoses  through  muscular  branches. 


RESUME   OF  THE   VEINS   OF   THE   SYSTEJTIC 
CIRCULATION. 

466  Divisions :     The  veins  above  the  diaphragm  all  end  in  the 

Superior  or  Descending   Cava,  and  all  the  veins  below  the 
diaphragm  end  in  the  Inferior  or  Ascending  Cava. 

SUPERIOR  OR  DESCENDING  CAVA  VEIN. 

Course.     It  extends  from  the  junction  of  the  two  innomi- 
nate veins  which  form  it  to  the  upper  part  of  the  right 
auricle. 
Situation  or  Relations.     The  Superior  Cava  is  in  relation : 

In  Front,  with  the  first  intercostal  space,  the  second 
costal  cartilage,  the  corresponding  portions  of  the  border  of 
the  sternum  and  the  second  intercostal  space. 

Behind,  with  the  root  of  the  right  lung. 

Externally,  with  the  apex  of  the  right  lung. 

Internally,  with  the  origin  of  the  aorta. 
Collateral  Branches :  The  Great  Azygos. — It  is  situated  in 
the  posterior  mediastinum,  to  the  right  of  the  vertebral 
column  and  thoracic  duct ; — it  arches  over  the  pedicle  of  the 
right  lung ; — it  empties  into  the  descending  cava. — It  re- 
turns the  blood  from  the  intercostal  spaces,  except  the  three 


INNOMINATE  VEIN — INTERNAL  JUGULAB  VEIN.  177 

upper. — Its  formative  branch  communicates  with  the  renal, 

and  even  the  ascending  cava. 

Formative  Branches:  The  left  and  right  innominate  veins. 

LEFT  INNOMINATE  VEIN. 

467  Course :  It  is  much  the  longer,  having  to  cross  over  to  the 
right  side  to  form  the  ascending  cava. 

Situation  or  Relations.     It  is  in  relation  : 

In  Front,  with  the  upper  border  of  the  sternum,  about 
one-quarter  of  an  inch  below  it ;  also  the  right  sterno- 
clavicular articulations. 

Behind,  with  the  left  subclavian  artery,  left  common 
carotid,  innominate  artery,  pneumo-gastric  nerve,  phrenic 
nerve,  thoracic  duct. 

Collateral  Branches:  It  receives  all  the  veins  which  ac- 
company the  branches  of  the  subclavian  artery,  except  the 
scapulars. 

It  receives  also  the  great  thoracic  duct. 
Formative    Branches :    Left    internal    jugular   and   sub- 
clavian. 

RIGHT  INNOMINATE  VEIN. 

468  Course:  Is  remarkably  short. 
Situation  or  Relations.     It  is  in  relation : 

In  Front,  with  the  right  sterno-elavicular  articulation. 

Behind,  with  the  innominate  artery. 
Collateral  and  Formative  Branches:   Same  as  for  left  in- 
nominate, except  that  it  receives  the  right  lymphatic  duct 
instead  of  the  thoracic  duct. 

INTERNAL  JUGULAR  VEIN. 

469  Course:  It  extends  almost  perpendicularly  from  the  base 
of  the  skull  to  the  superior  cava. 

Situation  or  Relations.     It  is  in  relation  : 

In  Front,  below,  with  the  tendon  of  the  sterno-mastoid  ; 
in  the  middle,  with  its  anterior  border  only;  above,  with 
the  skin  and  fascia. 

Behind,  with  the  vertebral  column,  the  pneumo-gastric 
and  the  sympathetic 

Internally,  with  the  common  carotid  and  the  internal 
carotid. 

Externally,  with  the  deep  cervical  lymphatic  glands,  the 
parotid  gland  and  the  pterygoid  muscles. 
Collateral  Branches:  The  veins  which  accompany  the 
brandies  of  the  external  carotid  artery,  except  the  internal 
maxillary!  the  posterior  auricular  and  temporal  veins  (which 
are  the  formative  branches  of  the  external  jugular). 
12 


178  SINUSES. 

Formative  Branches  :  The  two  lateral  sinuses  and  the  in- 
ferior petrosal  sinus. 

LATERAL  SINUSES. 

470  Situation  and  Course:  They  extend  horizontally  from  the 
Press  of  Herophilus  on  the  left  side  of  the  internal  occipital 
protuberance  to  the  mastoid  process ; — then  they  curve  in- 
wards and  downwards  to  the  jugular  foramen. 
Collateral  Branches:  1st,  Veins  from  cerebellum  and 
diploe; — 2d,  Mastoid  Vein; — 3d,  Superior  Petrosal  Sinus, 
which  originates  from  the  cavernous  sinus  and  runs  along 
the  superior  border  of  the  petrous  bone. 

Formative  Branches :  The  superior  longitudinal  sinus, 
the  straight  sinus  and  the  occipital  sinus. 

SUPERIOR  LONGITUDINAL  SINUS. 

471  Situation  and  Course.  It  corresponds  to  the  convex  or 
adherent  border  of  the  cerebral  falx. — (This  sinus,  the 
Cavernous  Sinuses  and  Lateral  Sinuses  are  the  largest  sinuses 
of  the  brain. J 

Collateral  Branches  :  Cerebral  and  diploic  veins. 
Formative  Branches :    Superior  nasal  vein,  which  passes 
through  the  so-called  blind  foramen. 

-  STRAIGHT  SINUS. 

472  Situation  and  Course.  It  is  situated  at  the  base  of  the 
cerebral  falx,  where  it  joins  the  tentorium. 

Collateral  Branches:  1st,  the  cerebral  veins; — 2d,  the 
inferior  longitudinal  sinus,  which  is  a  small  venous  tract 
corresponding  to  the  free  or  concave  border  of  the  cerebral 
falx. 

Formative  Branches  :  The  Veins  of  Galen  from  the  inter- 
posed veil. 

OCCIPITAL  SINUSES. 

473  Situation  and  Course:  They  are  two  small  tracts,  situ- 
ated on  the  margin  of  the  occipital  foramen. 

INFERIOR  PETROSAL  SINUSES. 

Situation  and  Course.  They  are  situated  along  the  pos- 
terior border  of  the  petrous  bone ;— they  extend  from  the 
cavernous  sinus  to  the  jugular  foramen. 
Collateral  Branches :  The  Transverse  Sinus,  which  is  situ- 
ated iu  front  of  the  occipital  foramen,  and  which  establishes 
a  transverse  communication  with  the  same  sinus  on  the 
other  side. 
Formative  Branches  :  The  cavernous  sinuses. 


SINUSES — ANASTOMOSES  BETWEEN  VENOUS  CIRCULATIONS.      170 


CAVERNOUS  SINUSES. 

474  Situation  and  Course.  They  are  situated  on  the  sides  on 
the  pituitary  body. 

They  contain  the  internal  carotid  artery,  the  third,  fourth, 
first  branch  of  the  fifth  and  the  sixth  pairs  of  nerves. 
Collateral  Branches :  1st,  Cerebral  Veins; — 2d,  the  Circu- 
lar Sinus,  which  surrounds  the  pituitary  body  in  the  sella 
turcica  and  which  establishes  a  communication  with  the 
cavernous  sinus  on  the  other  side. 

Formative  Branches:  The  Ophthalmic  Vein,  which  returns 
the  blood  from  all  the  parts  contained  in  the  orbit  behind 
the  broad  ligaments  of  the  lids. — It  inosculates  with  the 
facial  vein  at  the  internal  angle  of  the  eye. 

CLASSIFICATION  OF  THE  SINUSES. 

475  Important  Sinuses :  The  only  important  sinuses  are  the 
Lateral,  the  Superior  Longitudinal,  the  Straight,  the  Supe- 
rior Petrosal,  Inferior  Petrosal,  the  Transverse  and  the  Cav- 
ernous. 

The  Cerebral  Sinuses  are  the  first  three,  the  Lateral,  Su- 
perior Longitudinal  and  the  Straight,  which  return  the 
blood  from  the  brain  alone. 

The  Superior  Longitudinal  receives  the  blood  from  the 
surface  of  the  brain. 

The  Straight  Sinus  receives  the  blood  from  the  interior 
Of  the  brain  through  the  interposed  veil  and  the  Veins  of 
Galen. 

The  Orbital  Sinuses  are  the  Cavernous  and  the  Inferior 
Petrosal  Sinuses,  which  return  the  blood  from  the  orbit 
through  the  ophthalmic  vein. 
Anastomotic  Sinuses: 

The  Superior  Petrosal  Sinus  is  an  anastomotic  branch 
between  the  Cerebral  and  the  Orbital  Sinuses.  It  cor- 
responds to  the  posterior  communicating  artery. 

The  Transverse  is  an  anastomotic  branch  between  the 
cavernous  sinuses  of  the  two  sides.  It  corresponds  to  the 
anterior  communicating  artery. 

The  two  Lateral  Sinuses  anastomose  through  the  Press  of 
Herophilus. 

ANASTOMOSES  BETWEEN  THE  INTRA-CRANIAL  AND 
THE  EXTRA-CRANIAL  VENOUS  CIRCULATIONS. 

.476  1st.  Anastomose  of  the  facial  with  the  ophthalmic  at  the 
internal  angle  of  the  eye. 

2d.  Anastomose  of  the  superior  nasal  vein  with  the  supe- 
rior longitudinal  sinus. 


180  SUBCLAVIAN   VEIN. 

3d.  Anastomose  of  the  superficial  parietal  veins  with  the 
superior  longitudinal  sinus  by  means  of  the  veins  of  Sar- 
torius,  which  pass  through  the  parietal  foramina. 

4th.  Anastomose  of  the  superficial  occipital  veins  with 
the  lateral  sinuses  by  means  of  the  mastoid  veins,  which 
pass  through  the  mastoid  foramen. 

5th.  Anastomose  of  the  deep  veins  of  the  outside  of  the 
base  of  the  cranium  with  the  lateral  sinus  by  means  of  the 
condyloid  vein,  which  passes  through  the  posterior  condy- 
loid foramen. 

6th.  Anastomose  between  the  superficial  veins  and  the 
sinuses  by  means  of  the  Diploic  Veins. 

SUBCLAVIAN  VEIN. 

477  Course:  It  extends  from  the  innominate  vein  to  the  outer 
border  of  the  first  rib,  where  it  becomes  the  axillary. 
Situation  or  Relations :  The  Subclavian  Vein  is  in  rota- 
tion: 

In  Front,  with  the  sterno-clavicular  articulation. 

Behind,  with  the  subclavian  artery,  from  which  it  is  sepa- 
rated by  the  anterior  scalene,  the  pneumo-gastric  and 
phrenic  nerves. 

Below,  with  the  pleura  and  the  first  rib. 

Above,  with  the  large  lymph  ducts  and  the  skin. 
Collateral  Branches :  1st.  Of  all  the  veins  accompanying 
the  branches  of  the  subclavian  artery  it  receives  only  the 
Anterior  and  Posterior  Scapular  veins,  but  it  receives  the 
anterior,  external  aud  posterior  jugular  veins,  and  the 
cephalic. 

2d.  The  Anterior  Jugular  runs  downwards,  along  the 
the  anterior  border  of  the  sterno-mastoid, —  then  outwards 
across  the  sternal  and  clavicular  tendons  of  this  muscle. — 
It  opens  into  the  subclavian  just  behind  the  posterior  bor- 
der of  the  clavicular  ten  don. —  It  is  situated  above  the  fascia 
and  underneath  the  platysma  and  skin. — It  returns  the 
blood  from  the  superficial  median  parts  of  the  neck. 

3d.  The  External  Jugular  extends  from  the  space  between 
the  mastoid  process  and  the  angle  of  the  jaw,  downwards 
and  backwards,  to  the  junction  of  the  posterior  border  of 
the  sterno-mastoid  and  the  clavicle. —  It  crosses  the  sterno- 
mastoid  at  an  acute  angle;  also  the  fibres  of  the  platysma. 
—  It  is  situated  over  the  cervical  fascia  and  underneath  the 
skin  and  platysma. —  It  often  receives  the  posterior  jugular 
and  the  anterior  and  posterior  scapular  veins. —  It  is  formed 
by  the  junction  of  the  temporal  aud  internal  maxillary 
veins. 

4th.  The  Posterior  Jugular  is  deeply  seated  between  the 
muscles  of  the  back  of  the  neck ; —  it  is  often  of  large  size. 
— It  terminates  in  the  external  jugular  about  the  middle 
of  the  neck. 


AXILLARY    VEIN.  181 

5th.  The  Branch  from  the  Cephalic  crosses  over  the  clavicle 

and  opeus  near  the  border  of  the  trapezius. 
Formative  Branch  :    The  axillary. 

AXILLARY  VEIN. 

478  Course.     It  extends  from  the  outer  border  of  the  first  rib 
to  the  tendons  of  the  great  dorsal  and  great  pectoral. 
Situation  or  Relations:   The  Axillary  Vein  is  in  relation : 
In  Front,  with   the   costo-clavicular   membrane  and   the 
small  pectoral  muscle. 

Behind,  with  the  axillary  artery,  which  it  uncovers  a  little 
only  beyond  the  small  pectoral  muscle. 

Collateral  Branches:  1st,  All  the  reins  which  accompany 
the  branches  of  the  axillary  artery,  the  subscapular  vein 
especially; — 2d,  it   often   receives   the   Deep  Basilic   Vein; 

—  3d,  the  Cephalic,  which  extends  from  the  elbow  to  the 
clavicle; — it  ascends  along  the  outer  border  of  the  biceps, 
then  lies  in  the  pectoro-deltoid  groove  —  and  opens  into  the 
axillary  immediately  below  the  clavicle, —  after  giving  off  a 
superficial  branch  to  the  subclavian  vein. 

Formative  Branches :  Are  the  deep  and  the  superficial 
veins  of  the  upper  extremity. 

The  Beep  Veins  are  the  two  brachial  veins  which  accom- 
pany the  brachial  artery ;  they  are  themselves  formed  by 
the  two  deep  radial  veins  and  the  two  deep  ulnar  veins. 
The  Superficial  Veins  are  the  Median,  the  Superficial 
Radial,  the  Superficial  Ulnar,  the  Median  Basilic,  the 
Median  Cephalic,  the  Basilic  and  the  Cephalic. 

The   Median  Vein    runs   along    the    middle  of  the  fore- 
arm,  from  the  wrist  to  the  bend  of  the  elbow,  where  it 
divides  into  the  median  cephalic  and  the  median  basilic. 
The  Median  Cephalic  passes  upwards  and  outwards,  and  is 
joined  by  the  superficial  radial  vein. 

The  Median  Basilic  runs  along  the  inner  groove,  crossing 
obliquely  the  brachial  artery,  the  deep  brachial  veins  and  the 
median  nerve,  from  which  it  is  separated  by  the  fibrous  ex- 
pansion of  the  biceps ;  it  is  joined  by  the  superficial  ulnar. 

—  It  receives  a  large  anastomotic  branch  from  the  deep 
veins. 

The  Superficial  Radial  ascends  along  the  index  finger  and 

thumb,  and  then  on  the  radial  side  of  the  front  of  forearm 

to  the  bend  of  the  elbow,  where  it  joins  the  median  cephalic, 

the  two  forming  the  cephalic  vein. 

The  Superficial  Ulnar  ascends  along  the  little  finger,  then 

along  the  ulnar  side  of  the  front  of  the  forearm  to  the  bend 

of  the  elbow,  where  it  joins  the  median-basilic  to  form  the 

basilic  vein. 

The  Basilic  Vein  ascends  along  the   inner  border  of  the 

biceps  to  the  lower  third  of  the  arm,  where  it  pierces  the 

fascia  and  joins  one  of  the  deep  brachial  veins. 


182  ASCENDING  CAVA  VEIN — COMMON  ILIAC  VEIN. 

The  Cephalic  Vein  ascends  subcutaneously  along  the  onter 
border  of  the  biceps,  then  between  the  deltoid  and  the  pec- 
toral to  near  the  clavicle,  where  it  discharges  into  the 
axillary. 

INFERIOR  OR  ASCENDING  CAVA  VEIN. 

479  Course.     It  extends  from  the  fourth  lumbar  vertebra  to  the 
right  auricle  of  the  heart. 

Situation  or  Relations.     It  is  in  relation  : 

In  Front,  with  the  mesentery,  the  head  of  the  pancreas, 
the  special  groove  of  the  liver  and  the  fibrous  opening  in  the 
diaphragm. 

Behind,  witn  the  vertebral  column  and  pillar  of  dia- 
phragm. 

On  the  Left  with  the  Aorta. 

On  the  Right  with  the  psoas. 
Collateral  Branches:  It  receives  the  portal  hepatic  system 
of  veins,  the  reno-genital  veins  and  the  parietal  veins. 
1st.  The  Portal  Vein  is  formed  by  the  Splenic  and  the  Su- 
perior Mesenteric  Veins. 

Previously  to  joining  the  splenic,  the  Superior  Mesenteric 
receives  the  Inferior  Mesenteric. 

The  Portal  Vein  extends  from  the  neck  of  the  pancreas  to 
the  transverse  fissure. —  It  is  situated  in  the  left  of  the 
gastro-hepatic  omentum,  behind  the  common  bile  duct  and 
the  hepatic  artery,  in  front  of  the  foramen  of  Winslow  and 
the  ascending  cava. 

It  ascends  into  the  interior  of  the  liver. 

In  the  lobules  its  capillaries  and  those  of  the  arteries  are 
succeeded  by  the  capillary  radicles  of  the  hepatic  veins, 
which  all  gather  in  the  centre  of  the  lobules. 

The  hepatic  radicles  finally  form  three  large  Hepatic 
Veins  which  open  into  the  ascending  cava,  along  the  upper 
border  of  the  liver. 

The  walls  of  the  hepatic  veins  adhere  to  the  hepatic  tissue 
and  remain  gaping  when  cut  across. 

2d.  The  Reno=genital  veins  are  the  supra-renal,  the  renal 
and  the  spermatic  veins. 

3d.  The  Ascending  Cava  receives  also  the  parietal  veins, 
the  phrenic,  the  lumbar  and  the  spinal  veins. 
Formative  Branches :  Are  the  two  common  iliac  veins. 

COMMON  ILIAC  VEIN. 

480  Situation   and    Course:    It   extends  from  the  sacro-iliac 
junction  to  the  ascending  cava. 

The  Right?  is  at  first  on  the  inner  side  of  the  artery,  then 
passes  under  to  its  outer  side. 
The  Left  is  larger  and  longer  than  the  right. — It  is  at  first 


ILIAC  VEINS — FEMORAL  VEIN — POPLITEAL  VEIN.  L83 

under  the  left  artery,  then  crosses  in  front  of  the  fourth 
lumbar  vertebra  and  passes  under  the  right  artery. 

They  arc  both  eovered  by  the  peritoneum  and  are  crossed 
by  the  ureters. 

Collateral  Branches:    The  iUo-lumbar,    the   lateral  sacral 
and  the  spinal  veins. 

Formative    Branches   are   the   internal  and  the  external 
iliac  veins. 

INTERNAL  ILIAC  VEIN. 

481  It  corresponds  to  the  artery,  but  is  placed  behind  it. 

EXTERNAL  ILIAC  VEIN. 

Situation  and  Course:  It  extends  from  Poupart's  liga- 
ment to  the  sacro-iliac  articulation. — There  it  joins  the 
internal  iliac  to  form  the  common  iliac. —  Near  the  crural 
arch  it  is  on  the  inner  side  of  th3  artery,  but  higher  up  it 
passes  under  it  and  then  is  on  its  outer  side. 
Collateral  Branches:  The  circumflex  iliac  veins  and  the 
deep  epigastric  veins. 
Formative  Branch  is  the  femoral  vein. 

FEMORAL  VEIN. 

482  Situation  and  Course:  It  follows  the  artery. — Beneath 
Poupart's  ligament  it  is  on  the  inner  side  of  the  artery; — 
in  the  middle  third  of  the  thigh  it  is  behind  it ; —  at  the 
lower  third  it  is  on  the  outer  side. 

Collateral  Branches: 

1st.  The   Veins  corresponding  to  branches  of  thje  arteries. 

2d.  The  Internal  Saphenous  Vein,  which  is  a  superficial  vein. 
— It  ascends  along  the  inner  side  of  the  foot  —  and  then  in 
front  of  the  inner  malleolus  and  the  internal  border  of  the 
tibia. —  It  ascends  behind  the  inner  condyle  of  the  femur; — 
thence  upwards  and  a  little  forwards  —  to  the  special  open- 
ing for  it,  the  saphenous  opening,  in  the  fascia  lata,  about 
one  inch  below  Poupart's  ligament. 
Formative  Branch  is  the  popliteal. 

POPLITEAL  VEIN. 

483  Course:  It  extends  from  the  ring  in  the  great  adductor  to 
arch  of  the  soleus. 

Situation  and  Relations : 

Above  the  knee  it  is  on  the  outer  side  of  the  artery  and  on 
the  inner  side  of  the  nerve. 

Opposite  the  knee  it  covers  the  artery  and  is  covered  by  the 
nerve. 


184  PECULIARITIES  OF  VEINS  IN  PARTICULAR. 

Below  the  knee  it  lies  on  the  inner  side  of  the  artery  and 
on  the  outer  side  of  the  nerve. 

484  Collateral  Branches  :    Are  the  deep  veins  and  the  external 
saphenous  vein. 

1st.  The  Deep  Veins  are  the  branches  accompanying  the 
articular  arteries. 

2d.  The  Short  Saphenous  Vein  ascends  along  the  outer  border 
of  the  foot, —  passes  behind  the  external  malleolus, —  ascends 
along  the  outer  border  of  the  Achilles  tendon, —  and  thence 
along  the  middle  line  of  the  back  of  the  leg  to  the  middle 
of  the  popliteal  space ; — there  it  opens  into  the  popliteal  vein. 
Formative  Branches  are  the  deep  veins  of  the  leg  and  foot 
which  accompany  the  arteries :  the  two  anterior  tibial 
veins,  the  two  dorsal  veins  of  the  foot,  the  two  posterior  tibial 
veins,  the  two  external  and  internal  plantar  veins,  and  the  two 
peroneal  veins. 

PECULIARITIES  OF  VEINS  IN  PARTICULAR. 

485  Large  Arteries  are  accompanied  by  only  one  large  vein  ex- 
cept the  brachial,  which  has  two  small  ones. 

Veins  going  through  muscles  or  coming  from  muscles  are 
the  only  ones  provided  with  valves. 

Large  Veins  are  always  alongside  or  on  top  of  arteries, 
never  under,  with  but  two  or  three  exceptions,  which  will 
be  explained  further. 

Often  the  vein  is  the  more  superficial  and  is  first  met  by  the 
Tmife. 

They  often  overlap  the  artery  considerably. 
The  Superior  Cava  receives  but  one  collateral  branch,  the 
great  Azygos,  which  arches  over  the  pedicle  of  the  right 
lung. 

The  Left  Innominate  crosses  from  the  left  to  the  right  and 
is,  therefore,  much  longer  than  the  right. 

It  receives  the  Thoracic  Duct. 
The  Right  Innominate  is  much  shorter. 

It  receives  the  Right  Lymphatic  Duct. 
The   Innominate   Veins   receive   almost   all  the  branches 
which  correspond  to  the  arterial  branches  of  the  subclavian 
arteries. 

The  Internal  Jugular  Vein  adheres  to  the  posterior  lacer- 
ated foramen. 

It  usually  adheres  close  but  loosely  to  the  sterno-mastoid. 

It  anastomoses  freely  with  its  fellow  through  the  lateral 
sinus. 

The  Inferior  Thyroid,  the  Lingual  and  the  Facial  Veins, 
branches  of  the  Internal  Jugular,  cross  on  top  of  the  corre- 
sponding arteries. 

The  Head  has  two  remarkable  Superficial  Veins,  the  Frontal 
and  the  Temporal. 


PECULIARITIES  OF  VEINS  OF  SOME  ORGANS — DIGESTION.         185 

The  Face  has  a  Superficial  Vein,  the  Facial. 

It  follows  the  artery,  but  runs  a  straighter  course. 

[t  inosculates  with  the  ophthalmic  at  the  internal  angle  of 
the  eye. 
486  The  Neck  has  peculiar   superficial  or  subcutaneous  veins, 
which  are  the  External  and  the  Anterior  Jugular  Veins. 

(We  have  also  similar  subcutaneous  veins  in  the  arm  and 
leg,  none  in  the  trunk.) 

The  Subclavian  Vein  adheres  to  the  fascia  of  the  omo-hy- 
oid. 

The  Axillary  Vein  overlaps  the  artery  considerably,  espec- 
ially in  its  two  first  portions. 

The  Brachial  Veins  are  two  in  number,  whereas  there  is 
but  one  femoral  vein. 

The  Upper  JExtremiti/  has  peculiar  superficial  or  subcuta- 
neous veins,  which  are  the  Median  Basilic  and  the  Median 
Cephalic,  the  Cephalic  and  the  Basilic. 

The  Thoracic  Walls  are  drained  by  a  peculiar  vein,  the 
Great  Azygos,  which  arches  over  the  pedicle  of  the  right 
lung  to  discharge  into  the  Superior  Cava. 
The  Inferior  Cava  Vein  is  much  larger  after  receiving  the 
Hepatic  Veins  ;  also  after  receiving  the  Renal  Veins. 

The  peculiarities  of  these  veins  have  already  been  de- 
scribed. 

The   Common    Iliacs   and  the  External  Iliacs  pass  under 
the  arteries. 

The  Femoral  Vein  winds  around  the  artery  so  that  above  it 
is  internally,   then  posteriorly  in  the  middle  of  the  thigh, 
then  externally  in  Hunter's  canal. 
The  Popliteal  Vein  crosses  the  artery  obliquely. 

It  is  on  the  top  of  the  artery. 

It  is  below  the  nerve. 

The  Lower  Extremity  has  two  peculiar  superficial  or  subcu- 
taneous veins :  the  Long  or  Internal  Saphenous,  and  the 
Short  or  External  Saphenous. 


PECULIARITIES  OF  THE  VEINS  OF  SOME  0RQAN5. 

ORGANS  OF  DIGESTION. 

487  Lips:  The  veins  of  the  Upper  Lip  discharge  into  the  Facial, 
which  itself  inosculates  with  the  ophthalmic,  and  these  with 
the  Cavernous  Sinus  and  the  Sinuses  of  the  Brain. 
Tongue  :  The  Ranine  Veins  are  visible  through  the  mucous 
membrane. 

Parotid  :  The  Temporal  and  the  Internal  Maxillary  Veins 
join  the  substance  of  the  parotid  to  form  the  External  Jug- 
ular. 


186  ORGANS  OF  URINATION — ORGANS  OF  GENERATION. 

Stomach,  Small  and  Large  Intestines  to  Anas. — Their 
Veins  form  the  Portal  System. — They  have  no  valves. 
Spleen  :    Its  veins  also  form  the  portal  system. —  It  has  no 
valves  also. 

The  venous  capillaries  begin  by  dilated  extremities. 
Liver  :   It  receives  the  Portal  Vein. 

It  presents  the  Central  Intra-lobular  Hepatic  Vein. 

The  Hepatic  Veins  discharge  along  the  npper  border 
into  the  Ascending  Cava,  instead  of  coming  out  of  the  organ 
at  the  hilum. 

■  The  hepatic  veins  adhere  to  the  hepatic  tissue  and  remain 
gaping  when  cut  across. 

They  have  no  valves. 

There  are  two  hepatic  veins  for  the  right  lobe. 

There  is  only  one  for  the  left  lobe. 

ORGANS  OF  URINATION. 

488  Kidneys :  Renal  Veins. 

The  Right  is  lower  than  the  left. 

The  Left  is  longer  than  the  right,  and  crosses  over  from 
the  left  to  the  right. 

They  are  remarkable  for  their  size. 

They  originate  from  the  capillary  plexus  around  the 
lobules. 

They  have  no  valves. 

They  contain  redder  blood  than  the  arteries. 

The  Right  receives  the  Spermatic  Veins  direct. 

They  anastomose  with  the  lowest  branches  of  the  Azygos. 
Bladder : 

The  neck  is  surrounded  by  a  well  marked  plexus,  which 
receives  the  Dorsal  Vein  of  the  Penis. 
Prostate  :    It  is  also  surrounded  by  a  plexus  of  veins. 

ORGANS  OF  GENERATION. 
Scrotum : 

Its  veins  discharge  into  the  superficial  veins. 
Testicle  and  Epididymis: 

The  veins  follow  the  Spermatic  Duct. 

They  are  loosely  connected  with  the  duct,  whereas  the 
arteries  are  closely  attached  to  the  duct. 

On  the  Right  they  discharge  into  the  Renal  Vein. 

On  the  Left  they  discharge  into  the  Pampiniform 
plexus. 

They  have  no  valves. 
Penis : 

Has  one  Single  Dorsal  Vein. 

It  originates  by  open  dilated  extremities. 

It  discharges  into  the  Vesical  Plexus. 

It  has  no  valves. 


HEART — ORGANS  OF  RESPIRATION  AND  INNERVATION.  187 


HEART 

489  The  Proper  Tissue  or  Walls  present  the  Great  Coronary 
Vein  and  the  Small  Veins  of  Thebesius. 

The  Great  Coronary  Vein: 

Returns  the  blood  from  the  tissues  or  walls  of  the  thick 
left  heart. 

It  has  valves  in  its  course. 

It  presents  the  Thebesian  Valve,  at  its  opening  into  the 
right  auricle. 
The  Small  Veins  or  Veins  of  Thebesius: 

They  return  the  blood  from  their  right  walls  and  open 
directly  into  the  auricle. 
The  Right  Auricle  receives: 

The  Veins  from  the  walls. 

The  Superior  Cava  returning  the  blood  from  all  the  supra- 
diaphragmatic parts  of  the  body. 

The  Inferior  Cava,. returning  the  blood  from  all  the  infra- 
diaphragmatic  parts  of  the  body. 
The  Left  Auricle  receives: 

The  Four  Pulmonary  Veins. 

They  have  no  valves. 

They  contain  red  blood. 

The  left  Pulmonary  Veins  are  longer. 

ORGANS  OF  RESPIRATION. 

490  Bronchi : 

Their  Veins  are  separate  or  distinct  from  the  pulmonary 
veins. 

They  discharge  into  the   Azygos   veins,    or   some   close 
branch. 
Lungs : 

They  present  the  four  Pulmonary  Veins. 

They  originate  from  the  walls  of  the  air  vesicles. 

They  have  no  valves. 

They  discharge  into  the  left  auricle. 

The  left  are  longer. 

They  contain  red  blood. 
Thyroid   Body  : 

The  Veins  are  large  and  numerous. 

CENTRAL  ORGANS  OF  INNERVATION. 

491  Dura  Mater  of  Brain  : 

It  presents  the  Sinuses  of  the  Brain,  already  described. 
Cerebral    Veins. 

Superficial  Cerebral  Veins: 

They  are  situated  in  the  pia  mater. 

They  open  into  the  Superior  Longitudinal  Sinus,  against 
the  course  of  the  blood. 


188  ORGANS  OP  SPECIAL  SENSE — BONES — MUSCLES. 

They  discharge  in  the  various  neighboring  sinuses. 
Beep  Cerebral  Veins: 

They  originate  from  the  choroid  plexuses,  and  from  the 
walls  of  the  interior  cavities. 

They  form  the  Veins  of  Gallen,  situated  in  the  substance 
of  the  Interposed  Veil. 

The  Veins  of  Gallen  emerge  through  the  transverse  fissure 
of  the  brain  and  open  into  the  Straight  Sinus. 
Spinal  Veins : 

Are  large  and  numerous. 

They  empty  during  ventricular  systole,  and  make  room 
for  the  cerebro-spinal  fluid  from  the  cranium. 

ORGANS  OF  SPECIAL  SENSE. 

492  Nose: 

Its  veins  discharge  into  the  parotid  and  the  facial,  which 
inosculates  with  the  ophthalmic. 
Nasal  Cavities : 

The   Veins   at  the   Roof   anastomose  with  the   Superior 
Longitudinal  Sinus. 
Eyeball  and  Orbit : 

All  the  veins  behind  the  Broad  Ligament  discharge  into 
the  ophthalmic,  and  these  same  discharge  into  the  Cavern- 
ous Sinus. 
Choroid  : 

Its  veins  are  the  Four  Vorticose  Veins. 

They  emerge  from  the  eye  at  a  point  different  from  the 
point  of  entrance  of  the  arteries. 

The  Capillary  Veins  are  also  Vorticose. 
Retina : 

The  vein,  like  the  artery,  divides  in  the  optic  papilla  into 
an  upper  and  lower  arched  branch. 
Iris : 

Its  veins  discharge  into  the  Circular  Sinus  or  Canal  of 
Fontana. 
Eyelids ; 

All  the  veins  in  front  of  the  Broad  Ligament  discharge 
into  the  Facial. 

All  the  veins  behind  it  discharge  into  the  Ophthalmic. 

BONES. 

493  Diploe  of  Bones  of  Skull : 

Presents  Sinuses. 
Venules   are  usually   attached  to  the   bony  tissue,    hence 
hemorrhages  and  sepsis. 

MUSCLES. 

All  veins  which  traverse  muscles,  or  which  come  from 
them,  are  provided  with  valves. 


ARTERIES  AND  VEINS — LYMPHATIC  SYSTEM.  189 


ARTERIES  AND  VEINS. 

Veins  of  Arteries  and  of  Veins,  i.  e.,  Veins  of  the  Walls 
of  Arteries  and  of  Veins  : 

They  discharge  into  neighboring  small  venules,  not  into 
the  main  trunk. 


RESUME  OF  THE  LYMPHATIC  SYSTEM. 

494  Structure  of    Lymphatic  Vessels:    They  have  the  same 
structure  as  the  small  veins. 

The  radicles  of  the  lymphatics  originate  : —  1st,  in  spaces 
between  the  fascicules  of  the  connective  tissue  called  the 
lymph  spaces; — 2d,  in  the  spaces  between  the  so-called  fol- 
licles of  the  lymphoid  organs  and  called  the  lymph  sinuses; 
—  3d,  on  the  surface  of  the  serous  membranes  by  minute 
orifices. 

X.  B. — There  is  nowhere  any  communication  between  the 
lymph  radicles  and  the  capillaries,  either  direct  or  indirect. 

495  Structure  of  Lymphatic  Glands. 
They  are  composed  of : 

1st.  A  Cortical  and  a  Medullary  portion . 

2d.  An  Envelope  or  Capsule,  which  is  formed  of  delicate 
fibrous  tissue. 

3d.  A  Proper  Substance,  which  is  composed  of  alveoles 
filled  with  lymphoid  cells. 

4th.  Of  Afferent  Lymphatics,  which  penetrate  the  periph- 
ery of  the  gland  and  terminate  by  a  free  opening  into  the 
alveoles. 

5th.  Of  Efferent  Lymphatics,  which  originate  also  by  free 
openings  and  come  out  through  the  hilum. 

LYMPH. 

496  The  anatomical  elements  are  the  Lymph   Corpuscles,  which 
resemble  the  white  corpuscles  of  the  blood. 

The  lymph  corpuscles  are  few  before  passing  through  the 
lymphatic  glands ;  the  lymph  (and  the  chyle)  receive  their 
corpuscles  from  lymphatic  glands. 

CHYLE. 

497  The  anatomical  elements  are  the  Chyle  Corpuscles. 

They  are  analogous  to  the  lymph  corpuscles. 
Chyle   presents   also   fatty  granules,    oil   globules,   free 
nuclei  and  few  red  blood  corpuscles. 

The  Granular  Substance  of  the  chyle  poured  into  the  large 


190  THORACIC   DUCT — LYMPHATIC   DUCT. 

veins  of  the  neck  disappears  as  the  blood  passes  through  the 
lungs. 

Like  the  lymph,  chyle  contains  no  corpuscles  before  enter- 
ing the  lymphatic  glands,  but  they  are  numerous  after  leav- 
ing the  glands. 

The  milky  appearance  of  the  chyle  in  mammals  is  due  to 
innumerable  minute  dust-like  particles  formed  by  globules 
of  fat  enclosed  in  a  layer  of  albumen. 

The  Coagulum  of  Lymph  and  Chyle  may  become  red  by 
exposure  to  air. 

THORACIC  DUCT. 

498  Length  :  It  is  about  one  foot  long. 

Situation  and  Course :  It  extends  from  the  fourth  lumbar 
vertebra  to  the  junction  of  the  left  internal  jugular  and 
subclavian  veins. 

It  ascends  in  front  of  the  vertebral  column  lying  to  the 
right  of  the  aorta  and  to  the  left  of  the  ascending  cava. 

It  passes  into  the  chest  through  the  aortic  opening  of  the 
diaphragm,  and  ascends  between  the  aorta  on  the  left  and 
the  great  azygos  vein  and  oesophagus  on  the  right. 

At  the  upper  part  of  the  chest  it  arches  over  the  left  sub- 
clavian artery  to  open  as  already  described. 

Its  opening  is  guarded  by  a  valve. 
Collateral  Branches :  It  receives  all  the  lymphatics  from 
the  glands  of  the  left  side  of  the  head  and  neck,  left  arm, 
left  side  of  chest. 

Formative  Branches  are  the  lymphatics  from  the  lumbar 
and  aortic  glands,  which  themselves  receive  the  lymphatics 
from  the  glands  of  the  abdominal  and  pelvic  viscera  and 
walls  (both  sides),  and  from  the  two  lower  limbs. 

RIGHT  LYMPHATIC  DUCT. 

499  Length  :    It  is  not  more  than  one  inch  long. 

Situation  and  Course :  It  extends  from  the  right  supra- 
clavicular region  to  the  superior  mediastinum. 

It  is  situated  behind  the  right  subclavian  artery,  near  its 
junction  with  the  common  carotid. 

It  arches  over  the  right  subclavian  artery. 

It  opens  at  the  point  of  junction  with  the  right  internal 
jugular  and  subclavian  veins. 

Its  opening  is  guarded  by  a  valve. 
Collateral  and    Formative   Branches :  It  receives  all  the 
superficial  and  deep   lymphatics   from  the    right   side    of 
the  face,  neck  and  chest;  also  from  the  right  upper  ex- 
tremity 


SITUATION  OF  LYMPHATIC  GLANDS.  191 

SITUATION  OF  THE  LYMPHATIC   GLANDS  AND  THEIR 
AFFERENT  AND  EFFERENT  VESSELS. 

2f.  B. — The  Beep  Lymphatics  follow  the  deep  vessels  to 
reach  their  glands. 

The  Superficial  Lymphatics  follow  the  main  superficial 
vein  of  the  region  to  reach  their  glands  (as  facial,  ulnar, 
basilic,  internal  saphenous  veins). 

HEAD. 

500  1st.  The  Buccal  Glands  (on  buccinator  muscles)  receive 
lymphatics  from  the  frontal  region,  which  run  along  the 
frontal  and  facial  veins  and  discharge  into  the  deep  cervical 
glands. 

2d.  The  Parotid   Glands  receive  the  lymphatics  from  the 

ear,  temple,   outer  part  of  the  eyelids,  upper  part  of  the 

cheek,  and  discharge  into  the  deep  cervical  glands. 

3d.  The  Posterior  Auricular  Glands   receive   lymphatics 

from  the  skin  of  neighboring  parts  and  discharge  into  the 

deep  cervical  glands. 

4th.  The   Occipital    Glands   receive   lymphatics  from  the 

occipital  region  and  discharge  into  the  deep  cervical  glands. 

NECK. 

501  Superficial  Lymphatic  Glands  : 

1st.  The    Digastric   Glands   receive   the   lymphatics  from 

the  middle  of  the  lower  lip  and  discharge  into  the  deep 

cervical  glands. 

2d.  The  Submaxillary  Glands  receive  the  lymphatics  from 

the   outer  part   of    the  lips  and  discharge  into   the  deep 

cervical  glands. 

3d.  The  Supraclavicular  Glands  receive  lymphatics  from 

the   skin  of    neighboring  regions  and  discharge  into   the 

large  lymphatic  ducts. 

Deep  Lymphatic  Glands : 

The  Upper  Carotid  or  Cervical  and   Deep  Parotid  receive 

the  lymphatics  from  the  meninges,  cerebrum,  nasal  cavities, 

pharynx,  mouth,  temporal  and  orbital  fossa?,  and  discharge 

into  the  inferior  carotid  glands. 

The    Inferior    Carotid    or    Cervical    Glands    receive  the 

lymphatics  from  the  pharynx,  larynx,  trachea,  oesophagus 

and  thyroid  gland,  and  discharge  into  the  large  ducts. 

UPPER  EXTREMITY. 

502  Superficial  Glands: 

The  Epitrochelar  Glands  receive  the  inner  lymphatics  of 


192  CHEST — ABDOMEN. 

palmar  extract  of  forearm— and  discharge  into  the  axillary 

glands. 

Deep  Lymphatic  Glands: 

The  radial,  ulnar,  and  brachial  (very  small  glands)  are 
situated  along  the  arteries  ;—  they  discharge  into  the  axillary 
glands. 

Axillary  Glands  :  1st.  Group:  around  the  axillary  artery 
and  vein; — they  receive  all  the  vessels  from  the  above 
glands,  the  neck,  upper  umbilical  region  of  back  and  the 
shoulders. —  They  discharge  into  the  subclavian  glands. 

2d.  Group:  along  the  lower  border  of  the  great  pectoral : 
—  they  receive  lymphatics  from  epigastrium,  mammary 
glands,  the  sides  of  the  chest. — They  discharge  into  the 
subclavian  glands. 

Subclavian  Glands  (around  subclavian  vessels)  :  they  re- 
ceive all  the  vessels  from  the  above  glands. —  They  discharge 
into  the  large  ducts. 

CHEST. 

503  1st.  The  Anterior  Mediastinal  Glands  receive  lymphatics 
from  the  diaphragm  and  the  convexity  of  the  liver, — and  dis- 
charge into  large  ducts. 

2d.  Internal  Mammary  Glands  receive  lymphatics  from 
parts  supplied  by  the  artery — and  discharge  into  the  large 
ducts. 

3d.  Superior  Mediastinal  Glands  or  Cardiac  Glands  re- 
ceive lymphatics  from  the  heart,  pericardium  and  thymus 
gland, — and  discharge  into  the  thoracic  duct. 
4th.  The  Intercostal  Glands  receive  lymphatics  from  parts 
supplied  by  the  arteries, — and  discharge  into  the  large  ducts. 
5th.  The  Posterior  Hediastinal  Glands  or  Aortic  and 
Oesophageal  receive  lymphatics  from  oesophagus,  aorta 
and  areolar  tissue, — and  discharge  into  the  large  ducts. 
9th.  The  Bronchial  Glands  receive  lymphatics  from  the 
bronchi  and  lungs, — and  discharge  into  the  thoracic  duct. 

ABDOMEN. 

504  1st.  The  Gastric  Glands  (along  the  concave  border)  re- 
ceive the  lymphatics  from  stomach; — the  efferent  lym- 
phatics discharge  into  aortic  glands. 

2d.  The  Hepatic  Glands  (in  gastro-hepatic  omentum) 
receive  lymphatics  from  liver  and  stomach; — the  efferent 
lymphatics  discharge  into  aortic  glands. 
3d.  The  Splenic  Glands  (in  the  hilum  and  gastro- splenic 
omentum)  receive  lymphatics  from  spleen  and  stomach ; — 
the  efferent  lymphatics  discharge  into  the  aortic  glands. 
4th.  The  flesenteric  Glands  receive  lymphatics  from  the 
intestines;  they  are  the  lacteals; — they  discharge  into  the 
thoracic  duct. 


PELVIS — LOWER  EXTREMITY.  L93 

5th.  The  Lumbo-psoas  Glands  (in  front  of  insertions  of 

psoas  muscles)  receive  lymphatics  from  supra-renal  cap- 
sules, kidney,  body  of  the  uterus,  oviduct,  ovary,  testicles  ; 
—  they  discharge  into  the  thoracic  duct. 
6th.  The  Aortic  Glands  extend  from  aortic  opening  to  the 
bifurcation; — they  receive  lymphatics  from  stomach,  in- 
testines, liver,  spleen,  pancreas; — they  discharge  into  the 
thoracic  duct. 

PELVIS. 

505  1st.  The  Sacral  Glands  receive  the  lymphatics  from  the 
rectum,  bladder,  neck  of  uterus,  seminal  vesicles  and  pros- 
tate ; —  they  discharge  into  the  thoracic  duct. 
2d.  The  Internal  Iliac  Glands  receive  the  lymphatics  from 
rectum,  bladder,  neck  of  uterus ; — they  discharge  into  the 
lumbar  glands. 

3d.  The  Gluteal  and  Ischiatic  Glands  are  situated  along 
the  course  of  the  gluteal  vessels ; —  they  receive  the  lym- 
phatics accompanying  the  gluteal,  ischiatic  and  obturator 
arteries; — they  discharge  into  the  internal  iliac  glands. 
4th.  The  External  Iliac  Glands  receive  the  lymphatics 
accompanying  the  epigastric  and  circumflex  iliac  arteries  ; — 
they  discharge  into  the  lumbar  glands. 


LOWER  EXTREMITY. 

506  1st.  Superficial  Glands. 
Superficial  Inguinal : 

The  External  Glands  receive  the  lymphatics  from  the  skin 
of  the  buttocks  and  loins. 

The  Middle  receive  the  lymphatics  from  the  skin  below 
the  umbilicus  (outer  half). 

The  Internal  receive  the  lymphatics  from  the  inner  half  of 
the  skin  of  the  buttocks,  loins,  perineum,  anus,  scrotum, 
penis,  vulva,  and  origin  of  mucous  membrane  of  vagina. 

They  all  discharge  into  the  deep  scarpal  glands. 
The  Superficial  Scarpal    or   Saphenous  Glands  receive 
all  the  superficial  lymphatics  of  the  thigh  and  leg, —  aud  dis- 
charge into  the  deep  scarpal  glands. 
2d.   Deep  Glands. 

The  Deep  Scarpal  or  Femoral  Glands  receive  the  lymphatics 
from  the  popliteal  glands  and  the  superficial  glands, —  and 
discharge  into  the  external  iliac  glands. 
The  Popliteal  Glands  and  Anterior  Tibial  Glands  receive 
the  lymphatics  from  the  parts  supplied  by  the  vessels — and 
discharge  into  the  Scarpal  glands. 
13 


194  CAPILLARIES  OF  TISSUES  AND  ORGANS. 


PECULIARITIES  OF  LYMPHATICS. 

507  The  Lymphatics  of  the  right  side  of  the  head,  neck,  arm  and 
chest,  discharge  into  the  Right  Lymphatic  Dnct. 

The  Lymphatics  of  the  balance  of  the  body,  i.  e.,  of  the 
left  side  of  head,  neck,  arm,  chest,  of  both  sides  of  the  ab- 
domen and  back,  and  of  the  two  lower  limbs,  discharge  into 
the  Great  Thoracic  Duct. 

The  Lymphatics,  whether  Deep  or  Superficial,  follow  the 
veins,  except  those  of  the  middle  of  the  lower  lip,  which 
open  directly  into  the  Digastric  Glands. 

The  Lymphatic  Glands  are  always  on  top  of  the  veins. 
Around  the  orifices  of  the  body,  the  lymphatics  of  the  or- 
gans developed  from  the  External  Blastoderm  discharge 
into  the  superficial  glands  of  the  organ ;  those  of  the  Mu- 
cous Blastoderm  in  the  deep  glands. 

On  Serous  Membranes,  lymphatics  originate  by  open  ex- 
tremities. 


PECULIARITIES  OF  THE  CAPILLARIES  OF  SOflE 
TISSUES  AND  ORGANS. 

(JV.  B. — Unless  otherwise  mentioned,  the  blood  capillaries 
are  meant.) 

TISSUES. 

508  Connective  Tissue: 

The  lymphatics  originate  in  the  lymph  spaces. 
Adipose  Tissue : 

The  capillaries  form  a  globular  network  around  the  lob- 
ules. 
Glandular  Tissue : 

In  the  Racemose  and  Follicular  Varieties,  the  capillaries 
form  a  globular  network  around  the  lobules. 

In  the  Tubular  Glands  they  run  parallel  to  the  tubes. 

On  cross  section  they  present  a  radiating  appearance. 

ORGANS  OF  DIGESTION. 

509  Teeth : 

The  capillaries  form  a  characteristic  network  in  pulp. 
Tongue : 

The   capillaries   form  a   characteristic  tree-like  arrange- 
ment. 

It  is  poplar-like,  i.  e.,   long   and  narrow  in  the  conical 
papilla?. 

It  is  oak-like,  i.  e.,  broad  and  low  in  the  fungiform. 
Stomach  : 

The  capillaries  of  the  Tubular   Glands  alone  are  peculiar. 


ORGANS  OF  URINATION — MALE  ORGANS  OF  GENERATION.        L95 

Duodenum,  Jejunum  and  Ileum  : 

Thet blood  vessels  form  a  capillary  plexus  under  the  epi- 
thelium of  the  villi,  m  the  substance  of  the  stroma. 

The   lymphatics,   called    lacteals,   originate  by  a  closed 
dilated  extremity  in  the  centre  of  the  villi. 
Anus : 

Its  venous  capillaries  are  the  remotest  of  the  portal  system. 

Liver : 

The  capillaries  of  the  Portal  Vein  and  of  Hepatic  Artery 
form  around  each  lobule  a  plexus  which  sends  branches 
into  the  interior  of  the  lobule. 

The  Hepatic  Veins  orig'inate  in  the  centre  of  the  lobules 
by  the  Central  Intra-lobular  veins,  a  unique  case  in  the  body. 
Spleen  : 

The  Arterial  Capillaries  open  into  the  microscopic  alveoles 
by  a  free  extremity. 

There  are  no  Immediate  Capillaries  proper ;  they  are  re- 
placed by  microscopic  alveoles. 

The  Venous  Capillaries  originate  by  dilated  orifices  on 
the  inner  walls  of  the  microscopic  alveoles. 

The  Lymphatic  Capillaries  originate  from  peculiar  spaces 
in  the  adenoid  tissue,  called  "  lymph  spaces"  between  the 
microscopic  alveoles. 

ORGANS  OF  URINATION. 
510  Kidney: 

The  Arterial  Capillaries  circulate  between  the  Pyramids 
of  Ferrein  in  a  peculiar  branching  way,  and  give  off  the 
branches  which  form  the  Glomerule  of  Malpighi. 

From  this  Glomerule  originates  a  small  capillary  vessel, 
still  arterial,  which  breaks  up  into  a  second  set  of  capilla- 
ries at  the  initial  point  of  the  tubules.  Thus  it  forms  an 
arterial  capillary  portal  system,  a  unique  instance. 

The  Venous  Capillaries  originate  from  the  peritubular 
plexus  and  not  from  the  glomerule. 

The  Superficial  Venous  Capillaries  originate  in  a  star-like 
arrangement  called  the  Stars  of  Verheyn. 

MALE  ORGANS  OF  GENERATION. 

Testicles : 

The  Capillaries  form  a  vascular  layer  on  the  walls  of  the 
alveoles    before    being    distributed    to    the     seminiferous 
tubules  (like  the  pia  mater  and  the  periosteum). 
Penis : 

The  Arterial  Capillaries  have  a  corkscrew  course  —  and 
terminate  into  the  microscopic  alveoles  by  open  extremities. 


196      ORGANS  OP  RESPIRATION,  INNERVATION,  SPECIAL  SENSE. 

The  Intermediate  Capillaries  or  Capillaries  Proper  are  re- 
placed by  the  microscopic  alveoles. 

The  Venous  Capillaries  originate  from  the  microscopic 
alveoles  by  free  dilated  extremities. 

All  this  as  in  the  spleen. 

ORGANS  OF  RESPIRATION. 

511  Lungs: 

The  Capillaries  of  the  Bronchial  Arteries  and  Veins  do 
not  reach  the  interior  of  the  lobules. 

The  Capillaries  of  the  Pulmonary  Arteries  and  Veins 
form  three  sets  of  capillaries  :  one  around  the  lobules,  one 
between  the  air  vesicles,  and  one  under  the  epithelial  plates. 

CENTRAL  ORGANS  OF  INNERVATION. 

Brain : 

The  Capillaries  form  a  plexus  in  the  pia  mater  before 
penetrating  the  brain  substance. 

They  are  much  more  abundant  in  the  grey  matter. 

In    the   convolution,    and   especially  the    lamellae,  they 
present  a  characteristic  arborescent  arrangement. 
In  the  Spinal  Cord  : 

The  Capillaries  form  a  plexus  in  the  pia  mater  before 
penetrating  the  nerve  tissue. 

They  are  more  numerous  in  the  grey  matter. 

They  form  two  crescent-like  sets,  united  by  a  transverse 
set. 

ORGANS  OF  SPECIAL  SENSE. 

512  In  the  Nose. 

The  Tip  has  no  intermediate  capillaries,  and  the  arteries 
empty  directly  into  the  veins. 
In  the  Cornea. 

There  are  no  capillaries. 

There   exists   a  peculiar  set  of  Corneal  Corpuscles  and 
anastomosing  Canalicules. 
In  the  Choroid. 

The  Capillaries  form  a  separate  special  layer,  the  mem- 
brane of  Ruysch. — There  the  capillaries  present  a  peculiar 
stellate  or  spoke-like  arrangement. 
In  the  Retina. 

The  Capillaries  form  a  distinct  layer,  the  membrane  of 
Jacobson. 
In  the  Iris. 

The  Capillaries  have  a  corkscrew-like  course. 

They  form  a  plexus  around  the  greater  circumference  and 
a  smaller  one  around  the  pupil. 


ORGANS  OF  LOCOMOTION — STRUCTURE  OF  NERVES.     197 

111  the  Skin. 

The  Capillaries  form  peculiar  tree-like  projections  into 
the  papillae  (like  the  tongue). 

N.  B. — At  the  tip  of  the  nose,  in  the  matrix  of  the  nails, 
at  the  tip  of  the  fingers  and  toes  the  arterioles  run  directly 
into  venules  without  the  interposition  of  capillaries  proper. 

ORGANS  OF  LOCOMOTION. 

513  In  the  Bones. 

The  Capillaries  form  a  plexus  in  the  periosteum  and  in 
the  medullary  membrane  proper  before  penetrating  into  the 
bony  tissue. 

They  penetrate  into  the  bony  tissue  by  the  Haversian 
Canals. 

The  finest  capillaries  are  in  the  Haversian  Canal. 

They  do  not  penetrate  into  the  lacunae  and  canalicules. 
In  the  Muscles. 

The  Capillaries  run  parallel  to  the  fibres  and  interchange 
anastomotic  branches. 


STRUCTURE  OF  NERVES. 

514  The  nerves  are  composed  of  an  envelope  called  the  Neu- 
rilemma, and  of  contents,  the  Medulla  and  the  Axis- 
Cylinder. 

The  Neurilemma  is  composed  of  fine,  delicate,  structureless 

membrane. 

The  riedulla  is  a  fluid,  transparent,  fatty  substance. 

The  Axis=Cylinder  is  composed  of  very  fine  homogeneous 

fibrils. 

Forms  and  Varieties. 

Neurilemma. — Sometimes  it  is  quite  thick,  and  gives  the 
edges  of  the  fibres  the  aspect  of  a  double  line  (double  con- 
tour). 

Sometimes  it  is  so  thin  as  to  be  considered  absent  by  some 
(as  in  the  optic  and  auditory  nerves). 

Medulla. —  In  the  dead  state  it  is  coagulated. 

Sometimes  it  is  almost  entirely  absent,  as  in  the  fibres  of 
the  sympathetic  (fibres  of  Remak). 

TERMINATION  OF  NERVES. 

515  By  Loops:  is  not  admitted  by  all  anatomists. 

By  Free  Extremities:  i.  e.,  at  the  end  of  the  nerve  the 
axis-cylinder  divides  into  a  number  of  small  fibrils  (vestib- 
ular nerves). 


198  NERVOUS  GANGLIA — CRANIAL  NERVES. 

By  End  Bulbs  of  Krause :  i.  e.,  nrinute  corpuscles  in  the 
interior  of  which  the  axis-cylinder  passes  and  terminates 
in  a  coiled  plexiform  mass,  or  in  a  bulbous  extremity  (mu- 
cous membrane). 

By  Tactile  Corpuscles:  i.  e.,  minute  bodies  which  are  simi- 
lar to  the  end  bulbs,  but  complete  in  structure  and  more 
highly  sensitive. 

By  Pacinian  Corpuscles,  composed  of  a  capsule  of  many 
concentric  layers  of  connective  tissue  and  fluid,  presenting 
in  the  centre  a  cavity  in  which  the  axis-cylinder  terminates 
in  a  bulbous  extremity  (palm  of  hand — genitals  —  mesen- 
tery). 

By  Hair=Cells:  i.  e.,  the  axis-cylinder  terminates  into  a 
nerve  cell,  the  other  extremity  of  which  gives  off  a  number 
of  delicate  fibrils  (taste-goblets,  middle  scale  of  ear,  olfac- 
tory nerve). 
By  peculiar  Rods  and  Cones,  as  in  the  retina. 

STRUCTURE  OF  NERVOUS  GANGLIA. 

516  Nervous  Ganglia  are  formed  of  an  Envelope  of  fibrous 
tissue,  and  of  Nerve  Cells,  whose  poles  receive  the  axis- 
cylinder  of  nerves. 


RESUnE  OF  THE  CRANIAL  NERVES. 

517  1st.  Olfactory.  It  originates  from  the  anterior  perforated 
space. —  It  runs  along  the  olfactory  groove, —  it  terminates 
by  an  enlargement  called  the  bulb. 

From  the  bulb  are  given  off  filaments  which  descend 
through  the  cribriform  plate  and  are  distributed  to  the  upper 
third  only  of  the  Schneiderian  Membrane. —  The  filaments 
terminate  in  the  peculiar  hair  cells. 

518  2d.  The  Optic.  It  originates  from  the  quadrigeminate 
bodies  and  optic  beds.. 

It  winds  around  the  peduncles  of  the  cerebrum. —  the  two 
nerves  join  to  form  the  chiasma,  where  the  fibres  decussate. 

The  Optic  Nerve  Proper  is  round; — it  starts  from  the  chi- 
asma, enters  the  orbit  through  the  optic  foramen  with  the 
ophthalmic  artery,—  strikes  the  eyeball  a  little  below  and  to 
the  inner  side  of  the  axis, —  passes  through  the  sclerotic, 
—  expands  to  form  the  retina.— It  finally  terminates  in 
peculiar  bodies,  called  the  rods  and  cones. 

519  3d.  The  Common  Ocular  Hotor.  It  originates  from  the 
inner  side  of  the  cerebral  peduncles. 

It  passes  through  the  cavernous  sinus — it  enters  the  orbit 
through  the  sphenoidal  fissure.— It  is   distributed  to  the 


CRANIAL  NERVES.  199 

sphincter  of  the  iris  and  to  all  the  muscles  in  the  orbit,  ex- 
cept the  superior  oblique  and  the  external  straight. 

520  4th.  Pathetic.  It  originates  from  the  valve  of  Vieus- 
sens. — It  winds  around  the  cerebral  peduncle, —  it  passes 
through  the  cavernous  sinus, —  it  enters  the  orbit  through 
the  sphenoidal  fissure. 

It  is  distributed  to  the  superior  oblique  alone. 

521  5th.  Tri=facial.  It  originates  from  the  middle  peduncle  of 
the  cerebellum  by  a  large  sensory  root,  which  expands  to 
form  the  Gasserian  ganglion, — and  by  a  small  motor  root 
which  is  independent  and  joins  the  inferior  maxillary  nerve 
beyond  the  Gasserian  ganglion,  to  be  distributed  specially 
to  the  masticator  muscles. 

The  Gasserian  Ganglion  gives  off  the  ophthalmic  nerve, 
the  superior  and  the  inferior  maxillary  nerves. 

522  The  Ophthalmic  passes  through  the  cavernous  sinus  ; —  it 
enters  the  orbit  through  the  sphenoidal  fissure, —  and  is 
distributed  to  the  ophthalmic  ganglion,  the  lachrymal  gland, 
the  skin  of  the  forehead  (the  frontal  nerve)  and  the  skin  of 
the  wing  of  the  uose  (the  nasal  nerve). 

It  presents  the  Optic  or  Lenticular  Ganglion,  situated  on 
the  side  of  the  optic  nerve ; — its  branches  are  the  Ciliary 
Nerves  to  the  iris. 

The  Superior  Maxillary  leaves  the  cranium  through  the 
round  foramen. 

It  bridges  over  the  spheno-maxillary  fossa. 

It  runs  through  the  infra-orbital  canal; — it  emerges  upon 
the  face  at  the  infra-orbital  foramen  to  become  the  Infra-or- 
bital nerve; — it  is  distributed  to  the  skin  of  the  middle 
third  of  the  face. — In  the  spheno-maxillary  fossa  it  gives  off 
a  branch  to  Meckel's  ganglion. 

Collateral  Branches  :  To  the  upper  teeth  and  to  the  skin 
of  the  temple. 

It  presents  the  SpJieno-Palatine  or  Meckel's  Ganglion,  situ- 
ated between  the  nerve  and  spheno-palatine  foramen ; — its 
filaments  are  distributed  to  the  nasal  cavities,  palate  and 
pharynx. 

The  inferior  Maxillary  comes  out  through  the  oval  fora- 
men.— It  gives  off:  1st,  branches  to  the  masticator 
muscles; — 2d,  branches  to  the  ear  and  temple  (the  auriculo- 
temporal;— 3d,  the  gustatory  or  lingual  to  the  tongue, 
which  receives  the  cord  of  the  tympanum,  and  the  fila- 
ments of  which  terminate  in  the  taste  corpuscles  or  gob- 
lets ; — 4th,  the  inferior  dental  to  the  lower  teeth. 

It  presents  the  Otic  or  Arnold's  Ganglion,  situated  on  the 
inner  side  of  the  inferior  maxillary  nerve,  and  supplying 
the  pterygoids  and  the  tensor  of  the  palate. 

523  6th.  External  Ocular  Motor  or  Abductor.  It  originates 
from  the  groove 'between  the  Varolian  bridge  and  the  ante- 
rior pyramid. 


200  CRANIAL  NERVES. 

Jt  passes  through  the  cavernous  sinus  and  enters  the  or- 
bit through  the  sphenoidal  fissure. 

It  is  distributed  to  the  external  straight  muscle  alone. 

524  7th.  Facial.  It  originates  from  the  lioor  of  the  cerebellar 
ventricle. 

It  enters  the  internal  auditory  canal ; —  it  passes  through 
the  aqueduct  of  Fallopius,  where  it  gives  off  the  cord  of  the 
tympanum  to  the  gustatory; — comes  out  through  the  stylo- 
mastoid foramen; — winds  around  the  ramus  of  the  jaw; — 
passes  through  the  parotid  gland  to  its  anterior  border, 
and  it  divides  into  branches. 

It  is  distributed  to  all  the  cutaneous  muscles  of  the  face, 
i.  e.,  muscles  with  a  bony  origin  and  a  cutaneous  insertion. 

525  8th.  Auditory.  It  originates  from  the  floor  of  the  cerebel- 
lar ventricle ; —  it  runs  through  the  internal  auditory  canal 
in  close  apposition  to  the  facial; — it  is  distributed  to  the 
membranous  vestibule  and  the  membranous  cochlea; — in 
the  cochlea  its  filaments  terminate  in  the  peculiar  hair  cells. 

526  9th.  Glosso=pharyngeal.  It  originates  from  the  groove  be- 
tween the  olivary  body  and  the  restiform  body. 

It  leaves  the  cranium  through  the  jugular  foramen; — it 
passes  in  front  of  the  internal  carotid  artery. 

It  is  distributed  to  the  muscles  and  mucous  membrane  of 
the  pharynx  and  also  to  the  mucous  membrane  at  the  back 
part  of  the  tongue.. 

527  10th.  Pneumo=gastric.  It  originates  from  the  respiratory 
tract,  below  the  glosso-pharyngeal. 

It  leaves  the  cranium  through  the  jugular  foramen ; —  it 
descends  behind  the  internal  jugular  vein  and  internal 
carotid  artery  and  primitive  carotid; — it  passes  down  be- 
tween the  subclavian  vein  and  artery  on  the  right,  and  on 
the  left  between  the  vein  and  the  arch  in  front  of  the  left 
common  carotid ; —  upon  entering  the  chest  it  follows  the 
oesophagus  —  and  it  reaches  the  stomach. 

The  left  nerve  reaches  the  liver; — the  right  nerve  the  so- 
lar plexus. 

Collateral  Branches  are:  1st,  the  Pharyngeal  to  the 
pharynx; — 2d,  the  Superior  Laryngeal  to  the  crico-thyroid 
muscle  alone  and  to  the  mucous  membrane; — 3d,  the  Infe- 
rior or  Recurrent  Laryngeal,  which  winds  around  the  sub- 
clavian artery  on  the  right  and  the  arch  of  the  aorta  on  the 
left,  ascends  between  the  trachea  and  the  ossophagus  and  is 
distributed  to  all  the  muscles  of  the  larynx,  except  the 
crico-thyroid; — 4th,  the  Cervical  and  Thoracic  Cardiac 
nerves; — 5th,  the  (Esophageal; — 6th,  the  Bronchial  and 
Pulmonary  branches. 

528  11th.  Spinal  Accessory.  It  originates  from  the  lower  part 
of  the  respiratory  tract  of  Bell. 

It  leaves  the  cranium  through  the  jugular  foramen. 

It  passes  outward. 

It  is  distributed  to  the  sterno-mastoid  and  trapezius. 


SPINAL  NERVES — CERVICAL   AND   BRACHIAL   PLEXUS.  201 

529  12th.   Hypoglossal.    It  originates  from  the  groove  between 
the  anterior  pyramid  and  the  olivary  body. 

It  comes  out  through  the  anterior  condyloid  foramen  ; — 
it  descends  between  the  vein  and  artery  ; — it  crosses  the  ex- 
ternal carotid  ; — ■  it  runs  parallel  to  the  lingual  artery  and 
terminates  in  the  tongue. 

Collateral  Branches  to  the  muscles  of  the  infra-hyoid  re- 
gion (deseendens  noni)  after  anastomosing  with  a  branch 
from  the  cervical  plexus. 


RESUME  OF  THE  SPINAL  NERVES. 

530  The  Posterior  or  Sensory  Roots  originate  from  the  postero- 
lateral grooves. 

They  present  a  Ganglion  in  the  intervertebral  foramen. 

The  Ant  prior  or  Motor  Roots  originate  from  the  antero- 
lateral groove. 

They  join  the  posterior  branch  beyond  the  ganglion. 

The  Two  Sets  of  Roots  form  a  Single  Nerve  which,  at  its 
emergence  from  the  intervertebral  foramen,  divides  into  1st, 
a  Posterior  Branch ,  distributed  to  the  muscles  of  the  back ; 
2d,  an  Anterior  Branch,  which  anastomose  together  and 
form  the  spinal  plexuses  :  cervical,  brachial,  lumbar,  sacral. 

CERVICAL  PLEXUS. 

531  It  is  formed  by  the  anastomoses  of  the  anterior  branches  of 
the  first  four  cervical  nerves. 

It  gives  off  muscular  branches  to  the  surrounding  muscles, 
and  cutaneous  branches  to  the  skin  of  the  mastoid  region, 
ear,  neck,  clavicle  and  acromion. 

The  two  most  remarkable  branches  are  : 

1st-  The  Phrenic,  which  originates  from  the  third  and 
fourth ; —  descends  in  front  of  the  anterior  scalene  ; —  passes 
between  the  subclavian  vein  and  artery  on  the  right,  and 
the  vein  and  the  arch  of  the  aorta  on  the  left; — it  lies  be- 
tween the  pericardium  and  the  pleura; — it  ends  in  the 
diaphragm. 

2d.  The  Branch  which  anastomoses  with  tin  Descendens  Noni 
from  the  hypoglossal  (communicans  noni). 

BRACHIAL  PLEXUS. 

532  It  is  formed  by  the  anastomoses  of  the  anterior  brandies  of 
the  lower  four  cervical  and  first  dorsal  nerves. 

It  is  situated  between  the  scalenes,  above  the  subclavian 
artery  and  vein. —  Lower  down  it  surrounds  the  axillary 

artery. 


202     CUTANEOUS,  MUSCULO-SPIRAL,  MEDIAN  AND  ULNAR  NERVES. 

Collateral  Branches  :  Are  all  muscular  and  distributed  to 
the  neighboring  muscles. 

Terminal  Branches  :  Are  the  internal  cutaneous  nerves,  the 
circumflex,  the  musculo-spiral,  the  musculo-cutaneous,  the 
median  and  the  ulnar. 

INTERNAL  CUTANEOUS  NERVES. 

Are  distributed  to  the  skin  of  the  inner  region  of  the  arm. 

CIRCUMFLEX. 

It  winds  around  behind  the  neck  of  the  humerus. 

It  is  distributed  to  the  deltoid  and  small  round  muscle. 

MUSCULO-SPIRAL. 

It  follows  the  spiral  groove  of  the  humerus ;  —  it  reaches 
the  elbow, —  where  it  divides  into  the  radial  and  posterior 
interosseous. 

The  Radial  follows  the  long  supinator  to  the  wrist,  where 
it  turns  backward  and  is  distributed  to  the  back  of  all  the 
fingers,  except  the  little  finger  and  the  outer  half  of  the 
ring  finger. 

The  Posterior  Interosseous  passes  through  the  short  supina- 
tor and  is  distributed  to  all  the  muscles  of  the  back  of  the 
forearm. 

MUSCULO-CUTANEOUS. 

It  perforates  the  coraco -brachial. 

It  descends  between  the  biceps  and  brachial  muscle  ; —  it 
reaches  the  outer  part  of  the  elbow; — it  is  distributed  to 
the  skin  of  the  outer  region  of  the  forearm. 

MEDIAN. 

It  descends  between  the  fascia  and  the  brachial  artery, 
crossing  the  artery  obliquely ; —  at  the  elbow  it  passes  under 
the  arch  of  the  round  pronator, —  descends  between  the  su- 
perficial and  the  deep  flexors  to  the  wrist ; —  there  it  is  in 
front  of  the  tendons ; — it  passes  under  the  carpal  ligament; 
— it  is  distributed  to  the  muscles  of  the  thumb  and  to  the 
skin  of  the  palmar  surface  of  all  the  fingers,  except  the 
little  finger  and  the  outer  half  of  the  ring  finger. 

ULNAR. 

It  descends  along  the  internal  intermuscular  septum  to 
the  elbow; — it  passes  under  the  two  heads  of  the  ulno- 
carpal  flexor; — it  follows  this  muscle  to  the  wrist  on  the 
inner  side  of  the  pisiform  bone. 


INTERCOSTAL,  LUMBAR  AND  SACRAL  PLEXUS  NERVESi         203 

It  is  distributed  to  the  muscles  of  the  little  finger  and  to 
the  skin  of  the  palm  of  the  little  finger  and  inner  half  of 
the  ring  finger. 

Above  the  wrists  it  gives  off  a  branch  which  funis  to  the 
back  and  is  distributed  to  the  skin  of  the  back  of  the  same 
fingers. 

Below  the  wrist  it  gives  off  a  deep  branch,  which  passes 
down  into  the  palm  of  the  hand  with  the  deep  branch  of  the 
ulnar  artery; — it  supplies  all  the  deep  muscles  of  the  palm 
of  the  hand,  except  the  outer  two  lubricals. 

INTERCOSTAL  NERVES. 

533  They  are  the  anterior  branches  of  the  upper  dorsal  nerves. 

They  accompany  the  intercostal  arteries  in  the  intercostal 
spaces. 

They  give  off  a  branch  to  the  Sympathetic  and  the  Lateral 
Cutaneous  Xerres  to  the  thorax. 

LUMBAR  PLEXUS. 

534  It  is  formed  by  the  anterior  branches  of  the  upper  four  lum- 
bar nerves. 

It  is  situated  in  the  substance  of  the  psoas  muscle,  in  its 
posterior  portion. 
Collateral  Branches  are : 

1st.  The  Ilio-hypogastric,  the  Ilio-Inguinal,  the  External 
Cutaneous  and  the  Genito-crural,  which  supply  the  lower 
abdominal  walls,  the  skin,  of  the  upper  part  of  the  thigh 
and  of  the  scrotum. 

2d.  The  Obturator,  which  follows  the  obturator  artery. 
Terminal  Branch  :  Is  the  anterior  Crural  Nerve. 

It  comes  out  under  Poupart's  ligament,  lying  on  the  inner 
side  of  the  psoas  and  in  the  same  sheath  ; —  it  lies  to  the 
outer  side  of  the  femoral  artery. 

It  is  distributed  to  the  muscles  aud  skin  of  the  anterior 
region  of  the  thigh,  and  also  to  the  skin  of  the  internal  re- 
gion of  the  leg  by  means  of  the  Saphenous  Iferve,  which 
travels  in  the  sheath  of  the  vessels  to  the  knee,  where  it 
becomes  subcutaneous. 

SACRAL  PLEXUS. 

535  It  is  formed  by  the  anterior  branches  of  the  last  lumbar  and 
the  four  upper  sacral  nerves. 

//  is  situated  in  the  pelvis,  in  front  of  the  pyriform 
muscle. 

Collateral  Branches  :   Are  distributed  to  the  muscles  of  the 
buttock  —  and  to  the  skin  of  the  back  of  the  leg  through 


204  GREAT  SYMPATHETIC  NERVE. 

the  Small  Sciatic,  which  follows  the  ischiatic  artery  and  be- 
comes subcutaneous  below  the  popliteal  space. 
Terminal  Branch  :    Is  the  Great  Sciatic  Nerve. 

Situation:  In  front  of  the  pyriform  muscle. 

Course  and  Divisions:  It  leaves  the  pelvis  through  the 
lower  part  of  the  great  sacro-sciatic  notch,  below  the  pyri- 
form muscle; — it  is  placed  midway  between  the  great  tro- 
chanter and  the  ischiatic  tuberosity, —  it  descends  along  the 
back  part  of  the  thigh,  resting  on  the  great  adductor  and 
covered  over  by  the  biceps ; —  at  the  lower  third  of  the 
thigh  it  divides  into  the  internal  and  external  popliteal 
nerves. 

The  Internal  Popliteal  continues  the  course  of  the  nerve  to 
the  arch  of  the  soleus; — there  it  becomes  the  Posterior 
Tibial  nerve,  which  descends  along  with  the  posterior  tibial 
artery; — behind  the  internal  malleolus  it  becomes  the 
Plantar  Nerve,  which  divides  into  the  Internal  and  the  Ex- 
ternal Plantar  Nerves. 

The  External  Popliteal  Nerve  {or  Peroneal  Nerve)  follows 
the  tendon  of  the  biceps  ; —  it  pierces  the  origin  of  the  long 
peroneal  muscle, —  and  divides  into  the  Anterior  Tibial 
Nerve,  which  follows  the  anterior  tibial  artery  —  and  the 
Musculocutaneous,  which  passes  forward  between  the  pero- 
neal muscles  and  extensor  of  the  toes  and,  piercing  the 
fascia,  becomes  cutaneous. 

Distribution:  In  short,  the  Great  Sciatic  Nerve  is  distrib- 
uted to  the  sMn  of  the  posterior  region  of  the  thigh,  and  of 
all  the  leg  and  foot,  except  the  internal  region  of  the  leg ; 
to  the  muscles  of  the  posterior  region  of  the  thigh,  and  of 
all  the  leg  and  foot. 

GREAT  SYMPATHETIC  NERVE. 

536  It  forms  a  Chain  of  Ganglia  connected  by  nerves  — extend- 
ing from  the  base  of  the  cranium  to  the  coccyx. 

The  most  important  ganglia  are  the  Upper,  Middle  and 
Inferior  Cervical. 

It  is  situated  on  the  side  ot  the  vertebral  column. 
Afferent  Branches.  Each  ganglion  receives  a  communi- 
cating branch  from  the  anterior  branch  of  a  spinal  nerve. 
Efferent  Branches.  Each  ganglion  gives  off: — 1st,  the  fil- 
aments which  accompany  the  Arteries  and  their  Branches,  which 
form  plexuses  around  them,  and  thus  reach  the  viscera ; — 
2d,  Branches  having  an  Independent  Course:  the  three  Sympa- 
thetic Cardiac  nerves,  originating  from  the  cervical  ganglia — 
and  the  three  Splanchnic  Nerves,  which  originate  from  the 
lower  thoracic  ganglion,  pierce  the  diaphragm  and  terminate 
in  the  solar  plexus. 


PECULIARITIES   OF  NERVES    IN    PARTICULAR.  205 

PECULIARITIES  OF  NERVES  IN  PARTICULAR. 

CRANIAL  NERVES. 

537  The  Olfactory  : 

Is  a  soft  nerve. 
It  presents  a  grey  bulb. 

It  is  transmitted  through  a  cribriform  plate. 
Its  terminal  fibrils  end  in  hair-cells  between  the  epithe- 
lium. 

The  Optic : 

Is  a  soft  nerve. 

It  has  a  long  white  root  called  the  optic  bandelette. 

It  is  pierced  by  the  Central  Artery  of  the  Retina,  a 
unique  case. 

It  terminates  into  a  papilla. 

It  expands  to  form  the  retina. 

Its  terminal  fibrils  are  the  rods  and  cones. 

The  Common  Ocular  Motor: 

It  passes  through  the  cavernous  sinus. 

The  Pathetic : 

Is  remarkably  small. 

Presents  a  peculiar,  long  course. 

It  also  passes  through  the  cavernous  sinus. 

It  is  distributed  to  one  muscle  only,  the  Great  Oblique, 
which  receives  no  other  supply. 

538  The  Tri=facial : 

It  presents  a  Sensory  Root,  which  alone  forms  the  Gasse- 
rian  Ganglion. 

The  Motor  Root  does  not  enter  the  ganglion. 

This  motor  root  supplies  the  masticator  muscles  only. 

The  Three  Divisions  present  each  a  Ganglion :  the  Optic 
or  Lenticular,  Meckel  or  Spheno-palatine,  Arnold    or  Otic. 

It  gives  rise  to  a  nerve  of  special  sense,  the  Gustatory,  a 
unique  instance  of  a  nerve  of  special  sense  coming  from 
another  nerve. 

The  Gustatory  anastomoses  with  the  facial  (a  motor 
nerve),  through  the  Cord  of  the  Tympanum,  a  unique  in- 
stance of  the  anastomose  of  a  motor  nerve  with  a  nerve  of 
special  sense. 

The  terminal  fibrils  of  the  Gustatory  or  Lingual  end  into 
peculiar  bodies,  the  Taste-Goblets. 

The  Ophthalmic  Branch  of  the  Tri-facial  traverses  also 
the  cavernous  sinus. 

It  is  the  only  nerve  that  gives  off  the  three  kinds  of 
branches,  motor,  sensory  and  special  sense. 

The  External  Ocular  Motor: 

It  traverses  also  the  cavernous  sinus. 

It  is  distributed  to  one  muscle  only,  the  External  Straight. 


206  PECULIARITIES    OF   NERVES   IN   PARTICULAR. 

The  Facial : 

It  presents  a  peculiar  course  through  the  Internal  Audi- 
tory Canal,  through  the  Aqueduct  of  Fallopius,  and  through 
the  Parotid  Glaud. 

It  gives  rise  to  the  Cord  of  the  Tympanum. 

It  supplies  all  the  cutaneous  muscles  of  the  face,  head  and 
neck. 

The  Auditory : 

It  is  a  soft  nerve  (like  the  olfactory  and  optic). 

Between  it  and  the  facial  is  found  the  peculiar  nerve  of 
Wrisberg. 

It  penetrates  into  a  bony  canal,  the  Internal  Auditory 
Canal.* 

It  penetrates  into  the  Vestibule  and  the  Cochlea,  through 
cribriform  plates  (like  the  olfactory). 

Its  fibrils  end  in  nerve  cells  in  the  Vestibule,  between 
the  Auditory  dust  or  otoliths  (a  unique  instance). 

They  end  in  the  Cochlea  in  a  peculiar  manner,  in  the 
liquid  of  the  middle  scale. 

539  The  Glosso=Pharyngeal : 

It  originates  from  the  respiratory  tract. 
It  winds  around  the  internal  carotid,  between  it  and  the 
internal  jugular  vein. 

The  Pneumo=gastric: 

It  has  a  long  course. 

It  originates  from  the  respiratory  tract. 

It  descends  behind  the  Carotid  and  the  Jugular. 

It  gives  rise  to  the  Recurrent  Laryngeal. 

It  takes  support  on  the  oesophagus. 

The  Left  terminates  into  the  liver. 

The  Right  terminates  into  the  Solar  plexus. 

It  has  an  extensive  distribution,  to  almost  all  the  organs 
supplied  also  by  the  Great  Sympathetic  (respiration  circula- 
tion, digestion). 

For  that  reason  it  is  called  by  some  the  Small  Sympa- 
thetic. 

The  Spinal  Accessory : 

Originates  from  the  respiratory  tract,  i.  e.,  from  the 
sides  of  the  cervical  portion  of  the  spinal  cord. 

It  ascends  back  into  the  cranial  cavity. 

It  divides  at  the  exit  from  the  jugular  foramen  into  the 
branches  to   the  Sterno-mastoid,  and  the  branch  which  is 
the  real  origin  of  the  recurrent  laryngeal  nerve. 
The  Hypoglossal : 

Goes  through  a  foramen  by  itself. 

Winds  around  the  jugular  vein  and  the  internal  carotid. 

Below  it  crosses  the  external  carotid. 

Further  on  it  is  parallel  to  the  lingual  artery. 

It  gives  off  the  Descendens  Noni. 


I'KCULIAKITIKS    OF   THE    SPIXAL    NERVES.  207 


PECULIARITIES  OF  THE  SPINAL  NERVES. 

540  The  Posterior  or  Sensory  Root  presents  a  ganglion. 

The  Anterior  or  Motor  Root  joins  the  posterior  root  beyond 
the  ganglion  (like  the  Gasserian  Ganglion). 
The  Posterior  Spinal  Branches: 

Are  almost  all  small  and  comparatively  unimportant. 
The  Superficial  Branches  of  the  Cervical  Plexus: 

Are  cutaneous. 
The  Deep  Branches. 

Are  museular. 

The  Phrenic  is  the  most  important ;  it  is  peculiar  in  its 
course. 
The  Brachial  Plexus. 

Has  collateral  branches  which  are  all  museular. 

The  terminal  branches  go  to  the  upper  extremity. 
The  Musculocutaneous. 

Pierces  the  coraco-brachial  (like  the  radial  and  the  mus- 
culo-cutaneous  of  lateral  popliteal). 
The  Median  : 

Prongs  the  axillary  artery. 

It  crosses  obliquely,  the  brachial  artery  being  on  top. 
The  Circumflex: 

Winds  around  the  neck  of  the  humerus. 

It  supplies  the  deltoid  only,  which  receives  no  other 
supply. 

The  Musculo=Spiral  winds  around  the  spiral  groove  of  the 
humerus . 

The  Radial  winds  around  the  head  of  the  radius  and  the 
short  supinator. 

It  is  the  only  nerve  supplying  the  extensors  of  the  hand. 
The  Ulnar  can  be  compressed  between  the  ulnar  and  hume- 
rus at  the  elbow. 

541  The  Intercostal  Nerves  : 

Present  perforating  branches  which  are  the  painful  spots 
in  intercostal  neuralgia. 
The  Lumbar  Plexus : 

Gives  rise  to  one  important  branch  only,  the  Crural. 
The  Sacral  Plexus : 

Gives  rise  to  one  important  branch  only,  the  Great 
Sciatic. 

This  Great  Sciatic  is  the  largest  and  the  longest  nerve  in 
the  body. 

It  supplies  the  four-fifths  of  the  lower  extremity. 

It  accompanies  no  large  artery  nor  vein. 
The  Musculocutaneous  Branch  winds  around  the  head  <>t 
the  fibula  and  the  peroneal  muscles  (like  the  radial). 
The  Internal  Popliteal 

Is  on  top  of  the  Popliteal  vein  and  artery. 

It  crosses  the  artery  obliquely. 


208  RESUME   OF   SURGICAL  ANATOMY. 


GREAT  SYMPATHETIC. 


It  originates  from  ganglions  and  from  branches  from  the 
spinal  nerves. 

They  form  Peculiar  Plexuses  presenting  Peculiar  Gan- 
glions. 

The  Branches  from  these  Plexuses  take  support  upon  the 
arteries  to  reach  their  final  distribution. 


RESUME  OF  SURGICAL  ANATOMY. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  REGION  OF  THE  SKULL. 

542  1st.  The  Superior  Longitudinal  Sinus  corresponds  to  a 
line  drawn  over  the  head,  from  the  nasal  protuberance  to 
the  external  occipital  protuberance. 

2d.  The  Lateral  Sinuses  correspond  to  an  horizontal  line 
drawn  from  the  external  occipital  protuberance  to  the  ante- 
rior border  of  the  mastoid  process. 

3d.  The  Middle  Meningeal  Artery  corresponds  to  a  point 
about  an  inch  and  a  half  behind  the  external  angular  pro- 
cess of  the  frontal  bone,  and  an  inch  and  a  half  above  the 
zygoma. 

4th.  The  Lower  Level  of  the  Anterior  Lobe  in  Front 
corresponds  with  a  straight  line  drawn  across  the  forehead, 
just  above  the  eyebrows. 

5th.  The  Lower  Level  of  the  Middle  Lobe  corresponds 
to  a  line  drawn  from  the  external  angular  process  of  the 
frontal  bone  to  the  upper  part  of  the  external  auditory 
canal. 

6th.  The  Lower  Level  of  the  Posterior  Lobe  corresponds 
to  a  line  drawn  from  the  meatus  to  the  occipital  protuber- 
ance. 
7th.  The  Cerebellum  is  situated  below  this  line. 


RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  REGION  OF  THE  FACE. 

543  1st.  The  Supraorbital  Notch  corresponds  to  the  junction 
of  the  inner  third  with  the  middle  third  of  the  orbital  mar- 
gin. 

2d.  The  Infraorbital  Foramen  corresponds  to  the  root  of 
the  first  bicuspid  of  the  upper  jaw.  * 

3d.  The  Mental  Foramen  corresponds  to  the  root  of  the 
first  bicuspid  of  the  lower  jaw. 


RESUME  OF  ZYGOMATIC  FOSSAE,  PAROTID,  CAROTIDS.  209 

4th.  The  Facial  Artery  is  felt  at  the  anterior  inferior  angle 
of  the  masseter . —  Its  course  is  represented  by  a  line  ex- 
tending' from  that  angle  to  the  corner  of  the  month,  then 
along  the  naso-labial  fold  to  the  wing  of  the  nose;  thence 
the  internal  angle  of  the  eye. 

5th.  The  Facial  Vein  runs  a  straight  course  represented  by 
a  line  extending  from  the  internal  angle  of  the  eye  to 
the  anterior  inferior  angle  of  the  masseter. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  REGION  OF  THE  ZYGOMATIC 
AND  PTERYGO-MAXILLARY  FOSSAE. 

544  1st.  Steno's  Duct  runs  one-quarter  of  an  inch  below  the 
zygoma. 

2d.  Beyond  the  Masseter  and  Ramus  of  the  Jaw  is  the 

zygomatic  fossa, —  in  which  are  found  the  inferior  dental 
nerve,  the  pterygoid  muscles,  the  internal  maxillary  artery, 
and  the  lingual  or  gustatory  nerve. 

3d.  Beyond  the  Zygomatic  Fossa  is  found  the  pterygo- 
maxillary  fossa, —  which  contains  the  termination  of  the 
internal  maxillary  artery,  the  superior  maxillary  nerve  and 
Meckel's  ganglion. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST  CON- 
CERNING THE  REGION  OF  THE  PAROTID. 

545  1st.  Steno's  Duct  emerges  from  the  anterior  border  of  the 
gland,  about  one-third  of  an  inch  below  the  zygoma. 

2d.  The  Facial  Nerve  crosses  its  substance  in  the  upper 
third. 

3d.  The  Temporal  Artery  emerges  from  its  substance  in 
front  of  the  tragus. 

4th.  The  External  Carotid  is  between  it  and  the  inner  part 
of  the  neck  of  the  condyle. 

5th.  The  Internal  Maxillary  is  situated  between  it  and  the 
condyle  of  the  jaw. 

6th.  The  Internal  Jugular,  the  Internal  Carotid,  the 
Glosso=pharyngeal,  Pneumo=gastric,  Spinal  Accessory, 
and  Hypoglossal  correspond  to  the  deep  part  of  its  poste- 
rior surface. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST  CON- 
CERNING THK  REGION  OF  THE  CAROTIDS. 

546  The  Carotid  is  on  the  inner  side  of  the  internal  jugular 
vein,  which  overlaps  it  considerably. 

The  Pneumo=gastric  and  Sympathetic    descend  into  the 

groove  behind  the  vein  and  artery. 

14 


210  RESUME  OP  SUPRA-HYOID  AND  INFRA-HYOID  REGION. 

In  the  lower  third  the  vessels  are  entirely  covered  by  the 
tendons  of  the  sterno-mastoid  ; —  the  inferior  thyroid  artery 
is  behind  the  carotid. 

In  the  middle  third  they  are  covered  merely  by  the  ante- 
rior border  of  the  sterno-mastoid. 

In  the  upper  third  the  muscle  is  behind  them ; —  they  are 
under  the  skin  and  fascia. —  There  the  common  carotid 
divides. 

The  external  carotid  is  crossed  by  the  hypoglossal  nerve ; 
—  it  gives  off  the  superior  thyroid,  lingual,  and  facial. — 
The  jugular  vein  receives  there  the  superior  thyroid,  lingual 
and  facial  veins,  which  cross  over  the  arteries  to  reach  the 
jugular. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST  CON- 
CERNING THE  LATERAL  SUPRA-HYOID  REGION 
(DIAGASTRIC  TRIANGLE). 

547  1st.  The  Facial  Artery  crosses  the  posterior  extremity  of 
the  submaxillary  gland. 

2d.  The  Hypoglossal  Nerve  is  above  and  parallel  to  the 
upper  border  of  the  hyoid  bone. 

3d.  The  Lingual  Artery  has  the  same  course  as  the  nerve, 
but  is  underneath  the  fibres  of  the  hyoglossus  muscle. 

RESUME  OF  THE   POINTS   OF    SPECIAL   INTEREST 
.  CONCERNING  THE  INFRA-HYOID  REGION. 

1st.  The  Isthmus  of  the  thyroid  body  crosses  the  second 

and  third  rings  of  the  trachea. 

2d.  The  Anterior  Jugular  and  the  Middle  Thyroid  artery 

sometimes  run  on  the  middle  line. 

3d.  The    Innominate    Vein    and    Artery  in    children   are 

superficial  on  the  right  of  the  lower  part  of  this  region. 

4th.  The  Thymus  in  children  is  also  superficial. 

5th.  The  Recurrent  Laryngeal    Nerve   is  in  the  groove 

between  the  trachea  and  oesophagus. 

The  External  Jugular  Vein  crosses  the  region  obliquely, 

downwards  and  backwards. 

Its  course  is  represented  by  a  line  extending  from  the 
space  between  the  condyle  and  the  auditory  canal  to  the 
middle  of  the  clavicle,  behind  the  insertion  of  the  sterno- 
mastoid. 

The  Sterno-mastoid  Muscle  is  the  guide  to  the  region. 

The  Lymphatic  Glands  lie  under  the  muscle,  on  the  outer 
surface  of  the  Internal  Jugular  Vein.  They  are  small  and 
insignificant  in  health,  but  when  diseased  they  are  large 
and  become  adherent  to  the  vein. 


RESUME  OF  ANTERIOR  MEDIASTINUM.  21  1 

The  Internal  Jugular  Vein  is  on  the  outer  side  of  the 
artery. 

It  is  usually  a  little  adherent  to  the  muscle  and  follows  it 
when  the  muscle  is  pulled  away. 

RESUME     OF    THE     POINTS     OF     SPECIAL    INTEREST 
CONCERNING  THE  ANTERIOR  MEDIASTINUM. 

548  Sternum  : 

The  Top  corresponds  to  the  second  dorsal  vertebra* 

The  Junction  of  the  First  and  Second  Pieces  corresponds 
to  the  second  rib,  to  bifurcation  of  the  trachea,  to  the  third 
dorsal  vertebra. 

The  End  of  the  Sternum  Proper  corresponds  to  the  tenth 
dorsal  vertebra  and  to  the  lower  border  of  the  heart. 
Ribs: 

The  Nipple  of  the  Male  is  between  the  fourth  and  fifth 
ribs,  about  three-quarters  of  an  inch  to  the  outer  side  of 
their  cartilages. 

The  Lowe)-  Border  of  the  Great  Pectoral  corresponds  with 
the  direction  of  the  fifth  rib. 

The  Scapular  lies  on  the  ribs  from  the  second  to  the  sev- 
enth. 

The  Interior  Extremity  of  the  Third  Bib  corresponds  to  the 
body  of  the  sixth  dorsal  vertebra  (and  about  so  for  the 
others). 

The  Apex  of  the  Heart  corresponds  to  the  fifth  intercostal 
space. 
Lungs : 

They  leave  uncovered  a  circle  two  inches  in  diameter,  the 
centre  of  which  is  midway  between  the  nipple  and  the  end 
of  the  sternum. 
Heart: 

The  Parts  of  the  Heart  Behind  the  Sternum  are  the  pul- 
monary artery,  the  arch  of  the  aorta,  the  inner  half  of  the 
auricles  and  the  inner  half  of  the  ventricles. 

The  Parts  to  the  Bight  of  the  Sternum  are: 

The  Outer  Half  of  the  Right  Auricle  corresponding  to 
the  third  and  fourth  spaces. 

The  Superior  Cava,  corresponding  to  the  first  and  second 
spaces. 

The  Parts  to  the  Left  of  the  Sternum  are: 
The  Outer  Half   of    the  Ventricles,    corresponding  to  the 
third,  the  fourth  and  the  fifth  spaces. 

The  Base  of  the  Heart  corresponds  to  the  upper  border  of 
the  third  costal  cartilage. 

The  Apex  corresponds  to  the  fifth  intercostal  space.  It  is 
one  inch  below  the  left  nipple  and  one  inch  to  the  inner 
side  of  it. 


212    RESUME  OF  SUPERIOR  MEDIASTINUM,  CLAVICULAR  REGION. 

The  Lower  Border  of  the  Heart  corresponds  to  the  lower 
end  of  the  second  piece  of  the  sternum. 
The  Aortic  Valves  correspond  to  the  third  intercostal  space, 
close  to  the  left  side  of  the  sternum. 

The  Pulmonary  Valves  correspond  to  the  left  third  costo- 
sternal  articulation. 

The  Tricuspid  Valves  correspond  to  the  middle  of  the  ster- 
num, about  the  level  of  the  fourth  cartilage. 
The  Mitral  Valves  correspond  to  the  third  intercostal  space, 
one  inch  to  the  left  of  the  sternum. 

All  the  Valves   are  partially  covered  by  the  ear  applied 
over  the  sternal  end  of  the  third  intercostal  space. 


RESUME    OF    POINTS     OF     SPECIAL    INTEREST    CON- 
CERNING THE   SUPEIOR  MEDIASTINUM. 

549  Organs  Contained  on  the  Hiddle  Line: 

Thymus    gland, —  left    innominate     vein, — ascending    and 
transverse   aorta; — pulmonary  artery, —  origin  of  innomi- 
nate artery  and  of  left  carotid, —  the  trachea  and  bifurca- 
tion,—  oesophagus,  vertebral  column. 
Organs  Situated  on  the  Right  Side : 

Sterno-clavicular  articulation, —  internal  mammary  arte- 
ry,—  left  and  right  innominate  veins, —  superior  cava: — 
right  subclavian  vein  and  artery, — right  lymphatic  duct; — 
phrenic  nerve,  pneumo-gastric, —  recurrent  laryngeal, — 
right  vertebral  artery, —  and  sympathetic. 
Organs  Situated  on  the  Left  Side : 

Sterno-clavicular  articulation, — internal  mammary  arte- 
ry,— left  innominate  vein, —  left  subclavian  vein, —  origin  of 
the  left  common  carotid  and  left  subclavian  arteries, —  tho- 
racic duct,  —  phrenic,  —  pneumo-gastric  —  and  recurrent 
laryngeal  nerves,  descending  aorta, —  left  vertebral  artery  — 
and  sympathetic. 

RESUME     OF    THE     POINTS    OF     SPECIAL     INTEREST 
CONCERNING  THE  SUPRA-CLAVICULAR  REGION. 

550  1st.  The  Anterior  and  External  Jugular  Veins  open  into 
the  subclavian  behind  the  junction  of  the  sterno-mastoid  and 
the  clavicle. 

2d.  The  Cephalic  Vein  opens  above  the  middle  part  of  the 

clavicle. 

3d.  The  Anterior  Scapular  (or  Supra=scapular)  Artery 

runs  along  the  posterior  border  of  the  clavicle. 

4th.  The  Posterior  Scapular   crosses   obliquely   over  the 

subclavian  artery  and  the  nerves,  backwards  and  outwards. 

5th.  The  Lymphatic  Glands  are  on  the  veins. 

6th.  The  Subclavian  Vein  is  behind  the  clavicle. 


RESUME  OF  CLAVICULAR  REGION  AND  ARM.  213 

7th.  The  Artery  is  behind  the  vein  separated  by  the  ten- 
don of  the  anterior  scalene. 

8th.  The  Nerves  of  the  Brachial  Plexus  are  behind  and 
above. 

9th.  The  Phrenic  Nerve  is  on  the  anterior  scalene  near  its 
inner  border. 


RESUME     OF    THE     POINTS     OF     SPECIAL    INTEREST 
CONCERNING   THE   INFRA-CLAVICULAR   REGION. 

551  The  Great  Pectoral  lies  over  the  vessels. 

The  Vessels  are  covered  directly  by  the  costo-coracoid  mem- 
brane and  small  pectoral  muscle. 

Inside  the  Small    Pectoral    the    vein   is  in  front    of    the 
artery  ; —  there  the  cephalic  opens  into  the  axillary  vein. 
Outside  of  the  Small  Pectoral  the  vein   is  a  little  below 
the  artery; — the  brachial  plexus  is  external  to  the  artery. 

RESUME    OF    THE     POINTS     OF     SPECIAL     INTEREST 
CONCERNING  THE  AXILLARY   REGION. 

552  After  cutting  through  the  fascia  : 

The  Ulnar  and  the  Internal  Cutaneous  are  on  the  inner 

side  of  the  artery. 

The  Median  Nerve  is  commonly  on  the  outer  side  of  the 

artery;  above,  its  roots  embrace  the  artery  like  a  prong. 

The  Lymphatic  Glands  are  on  the  vein. 

The  Axillary  Vein  lies  on  the  inner  side  of  the  artery,  but 

almost  covering-  it. 

The  Artery  is  on  the  outer  side  of  the  vein. 

It  is  parallel  and  closely  applied  to  the  coraco-brachial. 
which  is  the  snide  to  it. 


RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  INTERNAL  REGION  OF  THE 
ARM. 

553  After  penetrating  the  fascia  : 

The  Median  Nerve  crosses  the  artery  obliquely  so  that  in 
the  upper  part  of  the  region  it  is  situated  on  the  outer  side 
of  the  artery,  between  it  and  the  edge  of  the  biceps. 

In  the  middle  it  is  on  top  of  the  artery  and  of  the  veins  : 
sometimes. 

At  the  lower  part  it  is  situated  at  the  inner  side  of  the 
arteries  and  of  the  veins. 

The  Region  presents  from  without  inwards  ; 

The  Inner  Edge  of  the  Biceps,  which  is  a  guide  to  the 
artery- 


214  RESUME  OF  ELBOW  AND  WRIST. 

The  Median  Nerve  as  explained  above. 
The   Brachial     Veins    covering    the     artery     almost  en- 
tirely. 

The  Brachial  Artery. 
The  Internal  Aponeurotic  Band. 
The  Ulnar  Nerve. 
The  Inner  Head  of  the  Triceps. 


RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST  CON- 
CERNING THE  INTERNAL  REGION  OF  THE  BEND 
OF  THE  ELBOW. 

554  There  are  two  lateral  regions  or  grooves,  and  one  middle 
region  or  depression. 
The  Internal  Lateral  Region  or  Groove : 

Is  limited  on  the  inside  by  the  round  pronator  and  on  the 
outside  by  the  biceps. 

It  presents  successively : 

The  Median  Brachial  Vein  under  the  skin ;  it  crosses  the 
artery  obliquely. 

The  Expansion  of  the  Biceps. 

The  Tendon  of  the  Biceps  on  the  outer  part  of  the  region. 

The  Brachial  Veins  covering  the  artery. 

The  Brachial  Artery  to  the  inner  side  of  the  tendon. 

The  Median  Nerve  to  the  inner  side  of  the  artery  and 
next  to  the  round  pronator. 
The  External  Lateral  Region  or  Groove : 

Is  limited  on  the  inside  by  the  biceps  and  on  the  outside 
by  the  long  supinator. 

It  presents  the  Cephalic  Vein  under  the  skin. 

Under  the  fascia  it  presents  the  terminal  part  of  the  Su- 
perior Deep  Profunda  Artery. 

Also  the  Musculo-spiral  nerve. 
The  Middle  Region  or  Depression  corresponds  to : 

The  bifurcation  of  the  brachial  arteries. 

The  junction  of  the  deep  veins. 

The  anastomotic  branch  between  the  deep  veins  and  the 
'  median  basilic  vein. 
The   Subscapular  Artery  and  Vein    are  situated  on  the 
anterior  border  of  the  scapula. 

The  Circumflex  Artery  and   Nerve  wind  around  behind 
the  neck  of  the  humerus. 


RESUME    OF    THE     POINTS     OF     SPECIAL     INTEREST 
CONCERNING  THE  WRIST 

555  1st.  Anterior  Region.  It  presents  on  the  Middle  Line  the 
anterior  carpal  ligament; — the  synovial  sac  of  the  flexor 
tendons, — with  the  median  nerve  in  front  of  it. 


RESUME  OF  HAND,   POSTERIOR  MEDIASTINUM,   HACK.  215 

It  presents  on  the  Ulnar  Side  the  ulnar  artery  and  nerve 
outside  the  tendon  of  the  ulno-earpal  flexor  and  pisiform 
bone. 

It  presents  on  the  Radial  Side  the  radial  artery  alone  (no 
nerve)  inside  the  tubercle  of  the  long  supinator. 
2d.  External  Region.  It  presents  on  the  radial  border  the 
radial  artery  (without  the  nerve)  which  crosses  obliquely 
the  pit  of  the  extensor  tendons  of  the  thumb. 
3d.  Posterior  Region.  It  presents  the  tendons  of  the 
extensor  muscles. 

RESUME     OP    THE     POINTS     OF     SPECIAL    INTEREST 

CONCERNING  THE  REGION  OF  THE  PALM 

OF  THE  HAND. 

556  It  presents  successively : 

1st.  The  Superficial  Palmar  Arch  under  the  fascia,  on  a 

line  with  the  extended  thumb. 

2d.  The  Lower  Cul=de=sac  of  the  Synovial  Sac. 

3d.  The  Deep  Palmar  Arch  under  the  tendons,  having  the 

same  direction  as  the  superficial  arch,  but  one-third  of  an 

inch  higher  up. 

RESUME     OP     THE     POINTS     OP     SPECIAL     INTEREST 
CONCERNING  THE  POSTERIOR  MEDIASTINUM. 

557  1st.  Aorta  and  (Esophagus : 

Above,  the  aorta  is  on  the  left  and  the  oesophagus  is  on  the 
right. 

In  the  Middle,  the  aorta  is  on  the  middle  line  and  the 
oesophagus  in  front,  on  the  median  line  also. 

Below,  the  aorta  is  on  the  median  line  still  and  the  oesoph- 
agus still  also  in  front  of  it,  but  on  the  left. 
2d.  The  Pneumo=gastric  Nerves  follow  the  oesophagus. 
3d.  The  Great  Azygos  Vein  is  situated  on  the  right  side  of 
the  vertebra?. 
4th.  The  Thoracic  Duct : 

Below,  lies  between  the  aorta  and  the  great  azygos. 

Above,  opposite  the  fourth  dorsal  vertebra,  it  ascends  to 
the  left  of  the  oesophagus,  lying  between  it  and  the  aorta. 
5th.  The  Great  Sympathetic  lies  on  the  heads  of  the  ribs. 

RESUME    OF     THE     POINTS     OF     SPECIAL     INTEREST 

CONCERNING  THE  LATERAL  REGION 

OF  THE  BACK. 

558  1st.  The  Space  between  the  Sixth  and  Seventh  Ribs  cor- 
responds to  the  upper  border  of  the  liver. 

2d.  Tenth  Rib.     The  liver  comes  in  contact  with  the  ribs. 


216  RESUME  OF  SPINAL  REGION  AND  ABDOMEN. 

3d.  The  Eleventh  Rib  on  the  left  side  corresponds  to  the 
lower  extremity  of  the  spleen. 

4th.  Twelfth  Rib.  The  most  accessible  point  of  the 
kidney  is  below  the  last  rib  and  the  outer  edge  of  the  spinal 
erector. 

5th.  The  Lower  Extremity  of  the  Kidney  (also  the  um- 
bilicus) corresponds  to  the  spine  of  the  third  lumbar  ver- 
tebra. 

6th.  The  Colon  is  situated  one  inch  to  the  outer  side  of  the 
outer  border  of  the  spinal  erector. 

7th.  The  Highest  Point  of  the  Ileum  corresponds  to  about 
the  spine  of  the  fourth  lumbar  vertebra. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  MIDDLE  REGION  OF  THE  BACK 
OR  SPINAL  REGION. 

559  The  Fourth  Cervical  Vertebra  (body)  corresponds  to  the 
end  of  the  pharynx — beginning  of  oesophagus, —  cricoid 
cartilage, —  phrenic  nerve, —  beginning  of  brachial  plexus. 
The  Third  Dorsal  Vertebra,  to  bifurcation  of  trachea, — 
base  of  heart, —  origin  of  aortic, —  pulmonary  arteries, — 
junction  of  the  two  pieces  of  the  sternum. 

The  Eighth  Dorsal  Vertebra,  to  aponeurotic  centre  of  dia- 
phragm,—  lower  border  of  heart, — Tower  extremity  of 
sternum  (not  appendix). 

The  Twelfth  Dorsal  Vertebra,  to  the  aortic  diaphragmatic 
opening, —  cardia, —  lowest  part  of  pleura. 
The  First  Lumbar  Vertebra,  to  the  coeliac  axis, —  solar 
plexus, —  renal  vessels, —  pelvis  of  the  kidney. 
The  Second  Lumbar  Vertebra,  to  the  termination  of  the 
spinal  cord. —  receptacle  of  the  chyle, —  pancreas, — duode- 
num. 

The  Third  Lumbar  Vertebra,  to  the  umbilicus, — lower 
border  of  kidney. 

The  Fourth  Lumbar  Vertebra,  to  bifurcation  of  aorta, — 
highest  point  of  the  ileum. 

The  Fifth  Lumbar  Vertebra,  to  promontory  of  sacrum ; — 
the  end  of  the  median  spinal  foramen  corresponds  to  the 
interval  between  the  spine  of  the  last  lumbar  vertebra  and 
that  of  the  first  sacral  vertebra. 

RESUME  OF  THE   ORGANS  OF   INTEREST   CONTAINED 
IN  THE  REGIONS  OF  THE  ABDOMEN. 

560  Right  Hypochondrium :  Right  lobe  of  liver  and  gall 
bladder, — pylorus, —  duodenum, —  head  of  pancreas, — right 
bend  of  colon, —  upper  part  of  right  kidney,— supra- renal 
capsule. 


RESUME  OF  MALE  PERINEUM  AND  INGUINAL  REGION.  217 

Epigastrium  :  Middle  of  left  half  of  liver  with  its  grooves  ; 

middle  and  pyloric  end  of  stomach, —  body  of  pancreas, — 

aorta, —  coaliac   axis, —  superior    mesenteric   artery, —  solar 

plexus, — thoracic  duct, — pillars  of  diaphragm. 

Left  Hypochondrium  :  Left  lobe  of  liver, — cardia, —  large 

extremity    of    stomach, — spleen, — tail    of    pancreas, — left 

bend  of  colon, — upper  part  of  left  kidney  and  capsule. 

Umbilical    Region:    Transverse   colon, —  jejunum, —  third 

portion  duodenum, — aorta,  ascending  cava, — thoracic  duct, 

—  fourth  lumbar  vertebra. 

Right  Lumbar  :  Jejunum, — ascending  colon, — lower  part  of 

right  kidney, — pelvis  and  ureter. 

Left  Lumbar  :  Jejunum, — descending  colon, — left  kidney, 

lower  half ; — pelvis  and  ureter. 

Hypogastrium  :  Ileum, — bladder  when  distended, — uterus 

in  pregnancy, — rectum  on  the  left, — promontory, — hollow 

of  sacrum,  first  and  second  pieces. 

Right  Iliac:  Ileum, — caecum  and  appendix, — external  iliac 

vessels, — iliac  and  psoas  muscles. 

Left  Iliac :  Ileum, — sigmoid  flexure, — external  iliac  vessels, 

— iliac  and  psoas  muscles. 

RESUME   OF  THE  POINTS   OF   SPECIAL   INTEREST 
CONCERNING  THE  MALE  PERINEUM. 

561  1st.  The  Central  Point  of  the  Perineum  corresponds  to  a 
point  on  the  raphe,  midway  between  the  centre  of  the  anus 
and  the  spot  where  the  scrotum  joins  the  perineum. 

The  perineal  muscles  all  meet  there. 

The  bulb  lies  above  this  point. 

The  artery  of  the  bulb  never  runs  below  it. 

It  corresponds  to  the  membranous  urethra  in  front  of  the 
prostate  and  neck  of  the  bladder. 

2d.  The  Two  Safety  Lines  of  the  Perineum  are:  1st,  the 
median  line : —  2d,  the  horizontal  line  passing  '  through 
the  centre  of  the  perineum. 

3d.  The  Dangerous  Zones  are : — 1st,  on  the  sides  of  the 
middle  line  and  above  the  transverse  line; — 2d,-  along 
the  ascending  ramus  of  the  ischium,  where  the  internal 
pudic  artery  lies. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  INGUINAL  REGION  (ILIO-INGUI- 
NAL). 

562  1st.  Pou part's  Ligament  corresponds  to  a  line  joining  the 
anterior  superior  spine  of  the  ilium  to  the  spine  of  the  pubis. 
2d.  The  Lymphatic  Glands  are  immediately  under  the 
skin,  on  Poupart's  ligament. 


218  RESUME  OF  UPPER  FEMORAL,  REGION. 

3d.  The  External  Abdominal  Ring  lies  between  the  spine 
of  the  pubis  and  the  angle  of  the  pubis. — It  gives  passage 
to  the  spermatic  cord  in  the  male  and  the  round  ligament  in 
the  female. — It  is  situated  immediately  above  the  spine. 
4th.  The  Inguinal  Canal  contains  the  spermatic  cord  in  the 
male  and  the  round  ligament  in  the  female. 
5th.  The  Internal  Abdominal  Ring  is  midway  between  the 
anterior  superior  spinous  process  of  the  ilium  and  the  spine 
of  the  pubis,  and  about  two-thirds  of  an  inch  above  Pou- 
part's  ligament; — the  cord  is  situated  at  the  lower  and  in- 
ternal angle  Of  this  ring. — The  epigastric  vessels  are  situ- 
ated on  the  inner  half  of  this  ring. — They  correspond  to  a 
line  drawn  from  the  middle  of  Poupart's  ligament  to  the 
umbilicus. 

6th.  The  Peritoneum  presents  usually : — 1st,  an  External 
fossa  or  depression  on  the  outer  side  of  the  epigastric  artery, 
and  corresponding  to  the  external  abdominal  ring ; — 2d,  a 
Middle  Fossa,  situated  between  the  obliterated  umbilical  ar- 
tery and  the  inner  side  of  the  epigastric  artery  correspond- 
ing to  the  external  abdominal  ring, — an  Internal  Fossa  situ- 
ated between  the  obliterated  umbilical  artery  and  the 
urachus. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST 
CONCERNING  THE  UPPER  FEMORAL  REGION 
•(SCARPA'S  TRIANGLE). 

563  Under  the  skin  are  found  : 

1st.  The  Lymphatic  Glands. 

2d.  The  Long  Saphenous  Vein. 

3d.  The  Cribriform  Fascia. 

4th.  The  Opening  of   the    Internal    Saphenous  Vein    is 

through  the  cribriform  fascia. 

5th.  The  Sartorius  is  on  the  outer  side  of  the  Crural  nerve 

and  of  the  artery. 

It  is  situated  below  the  inner  third  of  Poupart's  ligament, 
and  about  one  inch  and  a  half  external  to  the  pubic  spine. 
6th.  The  Anterior  Crural  Nerve  is  on  the  outer  side,  in  the 
sheath  of  the  psoas-iliac  muscle. 

7th.  The  Femoral  Artery  is  between  the  nerve  and  the 
vein,  in  the  same  sheath  with  the  vein. 

It  corresponds  to  the  upper  third  of  a  line  extending  from 
the  middle  of  Poupart's  ligament  to  the  tubercle  of  the 
great  abductor. 

8th.  The  Deep  Femoral  is  given  off  about  one  inch  and  a 
half  below  Poupart's  ligament; — it  is  situated  on  the  pos- 
terior and  external  part. 

9th.  The  Femoral  Vein  is  on  the  inner  side  of  the  artery 
and  overlaps  it  to  some  extent. 


RESUME  OF  THIGH,  FOOT  AND  GLUTEAL  REGION.  219 

10th.  The  Crural  Canal  corresponds  to  the  deep  lymphatics, 
and  is  on  the  inner  side  of  the  vein. 

11th.  The  Abdominal  Opening  of  this  canal  is  limited  in 
front  by  Ponpart's  ligament, —  externally  by  the  femoral 
vein, —  posteriorly  by  the  pubis, —  and  internally  by  the  sharp 
edge  of  Gimbernat's  ligament. 

It  is  half  an  inch  to  the  inner  side  of  the  femoral  artery. 

It  is  about  one  inch  external  to  the  spine  of  the  pubis. 

It  is  below  the  line  of  Poupart's  ligament. 

When  the  obturator  artery  originates  from  the  external 
iliac  it  curves  along  the  upper  and  internal  portion  of  the 
opening. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST  CON- 
CERNING THE  INTERNAL  REGION  OF  THE  THIGH 
(MIDDLE  THIRD). 

564  1st.  The  Internal  Saphenous  Vein  is  on  the  inner  part  of 
the  region,  between  the  skin  and  fascia. 

2d.  The  Sartor i us  covers  the  vessels. 

3d.  The  Artery  is  deeply  seated  in   the  groove   or   angle 

formed  by  the  adductors  and  internal  vast. 

This  groove  is  completed  by  an  aponeurotic  arch  into  a 
canal  (Hunter's  canal). 

4th.  The  Vein  is  situated  above  on  the  inner  side  of  the 
artery,  but  lower  down  it  is  behind  the  artery. 

RESUME  OF  THE  POINTS  OF  SPECIAL  INTEREST  CON- 
CONCERNING  THE  DORSAL  REGION  OF  THE  FOOT. 

565  The  Dorsal  Artery  is  subcutaneous. 

It  rests  on  the  tarsal  bones  and  is  on  the  outer  side  of  the 
tendon  of  the  extensor  of  the  great  toe.' 

RESUME     OF    THE     POINTS     OF     SPECIAL     INTEREST 
CONCERNING  THE  UPPER  COXO-FEMORAL  REGION. 

566  The  Top  of  the  Trochanter  corresponds  to  Nelaton's  line, 
drawn  from  the  anterior  superior  spine  to  the  most  promi- 
nent part  of  the  tuberosity  of  the  ischium. — The  head  of  fl>< 
femur  faces  in  the  same  direction  as  the  internal  condyle  of 
the  femur. 

RESUME    OF    THE     POINTS     OF     SPECIAL     INTEREST 
CONCERNING  THE   GLUTEAL   REGION. 

1st.  Gluteal  Vessels  and  Nerves.  Their  point  of  emer- 
gence corresponds  to  the  inner  third  of  a  line  drawn  from 


220  RESUME  OF  POPLITEAL  AND  MALLEOLAR  REGION. 

the  posterior  superior  spine  of  the  ilium  to  the  top  of  the 
great  trochanter  rotated  inwards. 

2d.  The  Ischiatic  Vessels  and  the  Sciatic  Nerve  emerge 
about  half  an  inch  below  the  gluteal ;—  the  nerve  is  exter- 
nal to  the  artery; — they  are  nearer  to  the  ischium  than  to 
the  trochanter. 

3d.  The  Internal  Pudic  Vessels  and  Nerve  emerge  at  a 
point  corresponding  to  the  inferior  third  of  a  line  drawn 
from  the  outer  side  of  the  ischium  to  the  posterior  superior 
spine ; — they  are  on  the  inner  side  of  the  ischiatic  vessels 
and  nerve. 


RESUME  OF  THE   POINTS    OF    SPECIAL  INTEREST 
CONCERNING  THE  POPLITEAL  REGION. 

567  Under  the  skin  : 

1st,  The  External  Saphenous  Vein  is  situated  on  the  mid- 
dle line  of  the  leg. 

It  dips  down  through  the  fascia  and  between  the  heads  of 
the  gastrocnemii. 

2d.  Above  the  Ligament  of  the  Joint  the  internal  pop- 
liteal nerve  is  on  the  outer  side  of  the  vein. 

The  vein  is  on  the  outer  side  of  the  artery. 

The  artery  is  on  the  inner  side  of  the  vein  and  is  next  to 
the  bone.     The  semi-membranous  is  the  guide  to  it. 
3d.  Opposite   the    Ligament   of  the  Joint,    between   the 
two  condyles  of  the  femur,  the  nerve  is  on  top  of  the  vein. 

The  vein  on  top  of  the  artery. 

The  artery  on  top  of  the  ligament. 
4th.  Below  the  Joint,  the  nerve  is  on  the  inner  side. 

The  vein  on  the  outer  side  of  it. 

And  the  artery  on  the  outer  side  of  the  vein,  and  resting 
on  the  popliteal  muscle  and  the  tibia. 

The  internal  head  of  the  Gastrocnemius  is  the  guide  to  it. 
5th.  The  External  Popliteal  Nerve  is  between  the  tendon 
of  the  biceps  and  the  outer  head  of  the  gastrocnemius. 

RESUME    OF    POINTS    OF     SPECIAL    INTEREST     CON- 
CERNING THE   INTERNAL  MALLEOLAR  REGION. 

568  1st.  The  Posterior  Tibial  Artery  is  covered  by  the  skin  and 
fascia, —  it  is  situated  between  the  tendons  of  the  long  flexor 
of  the  toes  and  the  long  flexor  of  the  great  toe. 
2d.  The  Tendon  of  the  Posterior  Tibial  is  in  front,  next 
comes  the  tendon  of  the  long  flexOr  of  the  great  toe,  and 
then  the  long  flexor  of  the  toes. 


DEVELOPMENT  OF  THE   OVUM.  -J21 

RESUME   OF   THE    POINTS    OF  SPECIAL  INTEREST 
CONCERNING  THE  PLANTAR  REGION. 

569  The  External  Plantar  Artery  is  deeply  seated,  lying  next 
to  the  bones, —  it  corresponds  to  a  line  drawn  from  the 
middle  of  the  internal  malleolus  to  the  posterior  extremity 
of  the  last  metatarsal  bone. 


DEVELOPHENT  OF  THE  OVUM. 

RESUME  OR  GENERAL  DESCRIPTION— VITELLINE 
MEMBRANE. 

570  The  ovum  is  composed  of  the  Vitelline  Membrane,  con- 
taining the  Vitellus  or  Yolk. 

The  ovum  meets  the  spermatoza  in  the  first  third  or  fourth 
of  the  oviduct. 

MULBERRY  MASS. 

571  The  Vitellus  undergoes  then  a  process  of  Segmentation  or 
Cleavage,  the  result  of  which  is  to  convert  the  granular 
contents  of  the  vitellus  into  a  mass  of  nucleated  cells, 
called  the  Mulberry  Mass. 

By  this  time  the  ovum  has  reached  the  uterus. 

DECIDUAL 

572  In  the  uterus,  the  lining  membrane  surrounds  the  ovum  in 
a  peculiar  manner,  and  forms  the  Decidua  Reflex  around 
the  ovum, —  the  Decidua  Serotina  under  the  ovum, —  and 
the  Decidua  Vera,  which  lines  the  rest  of  the  uterine 
cavity. 

VITELLINE  CHORION. 

573  The  Vitelline  riembrane  (or  covering  of  the  ovum),  which 
lies  immediately  beneath  the  decidua  reflex,  and  the  decidua 
serotina  become  then  covered  all  over  with  villi,  which  are 
implanted  in  these  decidua?; — it  forms  the  First  Chorion 
or  the  Vitelline  Chorion. 

This  chorion  is  transitory  and  disappears  as* soon  as  the 
vessels  are  developed. 

BLASTODERM. 

574  Now,  the  cells  of  the  surface  of  the  Mulberry  Mass  unite 
together,  are  flattened  and  condensed  so  as  to  form  a  mem- 


222  AMNION,  CHORION  AND  UMBILICAL  VESICLE. 

brane  called  the  Blastoderm,  which  lies  immediately  be- 
neath the  vitelline  membrane. 

On  the  surface  of  the  blastoderm  appears  the  Embryonal 
Spot,  composed  of  a  line  called  the  Primitive  Line  of  the 
Emory 'o,  surrounded  by  the  Transparent  and  the  Dark  Areas. 

The  blastoderm  then  divides  into  two  laminae : 
An  External  or  Serous   Lamina,  or  Epiblast,  which  will 
form  a  part  of  the  embryo,  the  amnion   and    the  blasto- 
dermic chorion, 

And  the  Internal  or  Mucous  Lamina,  or  Endoblast, 
which  will  form  the  umbilical  vesicle  and  some  of  the  in- 
ternal organs  of  the  embryo.  , 

The  Middle  Lamina  or  Mesoblast  is  between  the  two. 

AMNION. 

575  The  External  or  Serous  Blastoderm  forms  the  Amnion 
and  the  Amniotic  Cavity  by  arching  over  the  two  extremi- 
ties of  the  embryo  and  then  over  the  whole  of  the  abdominal 
and  dorsal  aspects  of  the  embryo. 

That  portion  of  the  blastoderm  which  forms  the  amnion 
is  the  Reflected  Portion. 

That  portion  which  still  remains  in  contact  with  the  vitel- 
line membrane  is  the  Parietal  Portion. 

The  space  or  cavity  between  the  parietal  and  the  reflected 
portions  contains  the  umbilical  vesicle  and  the  allantois. 

The  cavity  formed  by  the  reflected  portion,  or  the  amnion > 
contains  the  embryo. 

BLASTODERMIC  CHORION. 

576  The  external  surface  of  the  parietal  blastoderm  becomes 
covered  with  innumerable  Hollow  Villi,  forming  the  second 
or  blastodermic  chorion. 


UMBILICAL  VESICLE  AND  ITS  VESSELS. 

577  As  the  Amniotic  cavity  is  formed  and  extends,  the  Internal 
or  Mucous  Layer  of  the  blastoderm  assumes  the  form  of  a 
pediculated  vesicle,  which  becomes  more  and  more  pedicu- 
lated  as»the  amnion  enlarges. 

This  internal  lamina  is  divided  by  the  abdominal  opening 
or  umbilicus  of  the  embryo  into  two  portions  : 

One  is  contained  in  the  abdominal  cavity  of  the  embryo ; 
—  the  other  expands  externally;  it  forms  the  Umbilical 
Vesicle  Proper. 

The   membrane   of  the   vesicle   bears  vessels  called  the 


ALLANTOIS,  CHORION  AND  PLACENTA.  --■', 

Omphalo=mesenteric  Vessels. 

They  form  the  first  or  transitory  circulation  of  the  em- 
bryo. 

They  disappear  as  soon  as  the  placental  vessels  are  de- 
veloped. 

ALLANTOIS. 

578  When  the  amnion  is  about  half  formed  there  originates 
from  the  caudal  extremity  of  the  embryo  a  vesicle,  which  is 
the  Allantois. 

It  rapidly  expands,  occupies  a  large  portion  of  the  cavity 
between  the  amnion  and  the  blastodermic  chorion. 

As  it  expands  the  umbilical  vesicle  is  atrophied. 

It  bears  vessels,  the  Umbilical  Arteries  and  Veins,  which 
belong  to  the  second  or  permanent  circulation  of  the  em- 
bryo or  placental  circulation. 

ALLANTOID  CHORION. 

579  The  allantois  sends  membrano-vascular  prolongations,  which 
fill  the  cavity  or  the  hollow  villi  of  the  blastodermic  cho- 
rion. 

Those  prolongations  form  the  Third  or  Vascular  Chorion 
or  the  Allantoid  Chorion. 


PERMANENT  CHORION. 

580  The  blastodermic  chorion  and  allantoid  chorion,  uniting 
together,  form  the  Permanent  Chorion,  so-called  because 
a  portion  of  it  ultimately  forms  the  placenta. 

As  this  permanent  chorion  develops  the  vitelline  chorion 
and  membrane  atrophy. 

In  progress  of  time  the  villi  of  that  portion  of  the  blasto- 
dermic and  allantoid  chorions  which  correspond  to  the  reflex 
decidua  become  atrophied  and  blended  with  the  atrophied 
vitelline  chorion,  decidua  reflex  and  decidua  vera,  which, 
together  with  the  amnion,  form  the  walls  of  the  amniotic 
cavity. 

PLACENTA. 

581  The  decidua  serotina,  on  the  contrary,  enlarges  consider- 
ably, and  the  villi  which  correspond  to  it  ultimately  form 
the  Cotyledons  or  Lobules  of  the  placenta. 

The  decidua  serotina  forms  the  Foetal  Portion  of  the  pla- 
centa. 

The  serotina  itself  forms  the  Haternal  Portion  of  the 
placenta. 


224  DEVELOPMENT  OF  THE  EMBRYO. 


UMBILICAL  CORD. 


582  As  the  allantois  expands  it  becomes  more  and  more  pedicu- 
lated. 

It  is  that  pedicle,  together  with  the  amnion  and  the  re- 
mains of  the  umbilical  vesicle,  that  will  form  the  umbilical 
cord. 

RESUME  OF  DEVELOPMENT  OF  THE  EMBRYO. 

583  The  First  Trace  of  the  Embryo  is  a  Clear  Elliptical  Spot, 
which  dilates  above  and  below. 

It  presents  behind  the  Vertebral  Gutter,  in  which  the 
Dorsal  Cord  lies. —  It  forms  ultimately  the  intervertebral 
discs. 

It  is  then  converted  into  a  canal  by  the  Dorsal  Lamince. 
The  Abdominal  Cavity  of  the  embryo  is  closed  gradually 
by  the  Ventral  Lamince. 

The  Limbs  appear  (towards  the  fourth  and  fifth  week)  in 
the  shape  of  paddles,  the  pedicle  ultimately  forming  the 
limb  and  the  expansion  the  hand  and  foot. 
The  Sides  of  the  Face  and  the  Neck  are  closed  or  formed 
by  the  Branchial  Arches  separated  by  the  Branchial  Fissures. 
The  Nose  and  Middle  of  Upper  Lip  and  the  incisor  teeth 
are  formed  by  a  small  bud  from  the  forehead. 
The  Drum  of  the  Ear,  the  Eustachian  Tube,  the  Exter= 
nal  Ear  and  the  External  Auditory  Canal  are  formed  by 
the  first  branchial  fissure. 

The  Teeth  Sacs  are  depressions  of  the  mucous  membrane. — 
The  tooth  papilla  is  the  analogue  of  the  skin  and  hair  pa- 
pilla.— The  enamel  is  secreted  by  the  sac,  the  dentine  by 
the  papilla. — The  teeth  sacs  of  the  second  teeth  are  off- 
shoots of  the  sacs  of  the  first  teeth. 

584  The  (Esophagus  is  developed  independently  at  the  expense 
of  a  special  agglomeration  of  cells  ; — it  is  at  first  solid. 
The  Stomach,  Intestines  and  Rectum  are  formed  by  the 
lengthening  and  coiling  up  of  the  intra-abdominal  portion 
of  the  internal  or  mucous  blastoderm ;  — from  the  lower  or 
rectal  extremity  springs  the  pedicle  of  the  allantois. 

The  Liver  is  a  pediculated  offshoot  of  the  intestines. 

The  pedicle  forms  the  ducts. 

The  body  is  developed  by  lobules  and  lobes   which  fuse 
together. 
The  Spleen  is  a  diverticle  from  the  stomach. 

It  is  also   developed   by   lobules   and  lobes   which  fuse 
together. 
The  Pancreas  originates  like  the  liver. 

585  The  5upra=renal  Capsules  originate  independently; — they 
are  at  first  larger  than  the  kidney,  then  they  diminish  in 
size. 


DEVELOPMENT  OF  THE  EMBRYO.  225 

The  Kidneys  originate  independently  —  and  by  separate 
lobes  which  fuse. 

The  Pelvis  and  Ureter  are  also  developed  independently, — 
and  then  connect  with  the  kidney  and  bladder. 
The  Bladder  is  formed  by  the  dilatation  of  the  origin  of 
the  pedicle  of  the  allantois  ; —  the  upper  portion  of  the  pedi- 
cle of  the  allantois  forms  ultimately  the  uraclius. 
The  Urethrals  developed  separately  with  the  external  gen- 
ital organs. 

586  The  Ovaries  and  Testicles  are  developed  at  the  expense  of 
the  Wolffian  Bodies.  These  are  situated  in  the  lumbar  re- 
gion.— They  are  glandular  organs  provided  with  a  duct, 
which  opens  into  the  cloaca. 

The  gland  forms  the  ovaries  and  testicles, —  the  duct 
forms,  in  the  male,  the  guiding  cord, —  and  in  the  female  the 
round  ligament. 

The  Spermatic  Canal  and  Seminal  Vesicles  are  developed 
from  the  Canals  of  Midler, — they  extend  from  the  lumbar 
region  to  the  rectal  cavity  of  cloaca. 

The  Fallopian  Tubes,  Uterus  and  Vagina  are  formed  by 
the  coalescence  of  the  two  Canals  of  Muller. 

587  The  External  Organs  of  Generation  are  developed  sepa- 
rately and  independently  from  the  internal  organs, —  they 
coalesce  in  course  of  development. 

The  Larynx  is  developed  from  the  fourth  branchial  arch. 
The  Trachea,  Bronchi  and  Lungs  are  pediculated  off- 
shoots from  the  oesophagus  ;  the  pedicle  forms  the  bronchi 
and  trachea. 

The  Thyroid  Body  is  developed  independently. 
The  Thymus  also;  it  diminishes  after  birth. 

588  The  Heart  is  developed  separately ; — it  is  the  first  organ 
which  acts. 

At  first  it  is  a  cylinder,  giving  rise  above  to  arteries  which 
supply  the  embryo  and  the  umbilical  vesicle,  and  receive 
below  the  corresponding  veins. 

When  the  Allantois  and  Placenta  are  developed: 

1st.  The  umbilical  vein,  which  returns  arterial  blood  from 
the  placenta  to  the  ascending  cava,  gives  off  a  large  branch 
to  the  left  branch  of  the  portal  vein,  through  which  a  large 
amount  of  this  placental  blood  goes  to  the  liver. 

2d.  There  exists  an  orifice  between  the  auricles,  through 
which  the  blood  of  the  ascending  cava  vein  is  directed  im- 
mediately into  the  left  auricle. 

3d.  The  pulmonary  artery  is  connected  with  the  aorta  by 
a  canal  (ductus  arteriosus),  through  which  half  of  the  blood 
of  the  right  ventricle  is  directed  immediately  into  the 
aorta. 

589  The  Spinal  Cord  is  developed  from  the  internal  blastoderm 
in  the  vertebral  gutter. 

15 


226  APPEARANCE   OF  THE  MAIN    ORGANS. 

It  is  at  first  a  flat  membrane,  but  later  on  curves  its  edge 
and  forms  a  central  canal,  which  becomes  obliterated  in  the 
course  of  time. 

The  Brain  is  developed  from  the  spinal  cord  by  three  dil- 
atations or  cerebral  vesicles. 

590  The  Membranes  of  the  Eye  and  the  Optic  Nerve  are  de- 
veloped from  the  first  cerebral  vesicle ; — the  transparent 
media  are  developed  independently  from  the  intermediate 
blastoderm. — The  lids  and  lachrymal  apparatus  from  the 
skin. 

The  Membranous  Internal  Ear  is  an  emanation  from  the 
third  cerebral  vesicle; — the  osseous  labyrinth  is  developed 
independently  of  the  petrous  bone ; —  the  drum  of  the  ear, 
Eustachian  tube,  external  and  internal  auditory  canals  are 
formed  by  the  first  branchial  fissure; — the  external  ear  em- 
anates from  the  skin. 

The  Nose  Proper  is  formed  from  the  frontal  tubercle ; — 
the  nasal  cavities  are  formed  by  the  second  branchial  fis- 
sure;— the  olfactory  nerve  (root,  bulb,  and  filaments)  is  a 
vesicular  prolongation  of  the  first  cerebral  vesicle. 
The  Skin  and  Appendages  are  developed  at  the  expense 
of  the  external  blastoderm. 

591  The  Bodies  of  the  Vertebra?  are  the  first  bones  which  ap- 
pear on  the  sides  of  the  dorsal  cord,  in  the  vertebral  gut- 
ter.— Some  bones  are  developed  directly  into  bone,  whereas 
others  are  first  cartilaginous,  then  bony.. — The  main  parts 
of  bones  are  developed  separately  by  primary  points  of  ossi- 
fication.— Secondary  parts  are  developed  by  supplemental 
and  secondary  points  on  the  parts  first  developed. 

As  age  advances,  bones  lose  organic  matter  and  become 
light  and  brittle. 

The  Muscles  are  developed  at  the  expense  of  the  external 
blastoderm ; — those  of  the  back  appear  first. 

LAWS  OF  DEVELOPMENT. 

592  1st.  Law  of  Unity  of  Organization  and  of  Transitory 
Development,  by  virtue  of  which  each  transitory  stage  of 
the  development  of  most  of  the  important  organs  corre- 
sponds to  a  permanent  condition  in  some  of  the  lower 
animals. 

2d.  Law  of  Symmetry,  bv  virtue  of  which  the  body  gen- 
erally and  each  organ,  whether  single  or  double,  is  origin- 
ally divisible  into  two  parts,  each  half  growing  towards  the 
median  line,  where  they  meet  and  fuse. 

EPOCH  OF  APPEARANCE  OF  THE  MAIN  ORGANS. 

593  First  Week :  The  ovum  reaches  the  uterus  at  the  end  of 
the  first  week. 


APPEARANCE   OF   THE    MAIN"   ORGANS.  227 

Second  Week:  The  vitelline  chorion  is  formed. 

Third    and    Fourth    Weeks:    The   blastoderm,    umbilical 

vesicle  and  first  trace  of  embryo. 

At  end  of  First  Month  the  pancreas,  lungs,  liver,  allantois 

and  Wolffian  bodies  are  developed. 

First  half  of  Second  Month:   The  amnion,  allantois,  gen- 
ital organs,  intestines  and  lungs  are  formed. 
Second    half    of    the  Second  Honth :     Kidney,    stomach, 
spleen,  umbilical  cord  and  placenta  are  formed. 
Third  Month  :  The  embryo  has  acquired  definite  shape  and 
all  the  organs  are  distinct. 

Fourth  rionth  :    The  embryo  assumes  the  name  of  foetus; 
the  muscles  contract  perceptibly  and  the  foetal  heart  is  audi- 
ble. 
594  At   Birth  the  bones  of  the  top  and   sides  of  cranium  are 
not  yet  united. 

The  anterior  fontanelle  corresponds  to  the  angle  of  the 
frontal  parietal, 

And  the  posterior  fontanelle  to  the  angle  of  the  occipital 
and  parietal  bones. 
In  Resume : 

End  of  First  Week:   Ovum  reaches  the  uterus. 

End  of  Fourth  Week:   First  trace  of  the  embryo. 

End  of  Second  Half  of  Second  Month:   Umbilical  cord  aud 
placenta  are  formed. 

End  of   Third  Month:    The  embryo  has  its  definite  shape 
and  all  the  organs  are  distinct. 

End  of  Fourth  Month:  The  embryo  is  called  a  foetus;  the 
muscles  contract  perceptibly,  the  foetal  heart  is  audible. 

At  Birth,  as  above. 


QUESTIONS  ON   ANATOHY. 


GENERAL  HISTOLOGY. 

1.  Describe  the  Shape  and  the  number  of  Cells. 

2.  Give  a  Resume  of  the  Structure  of  Cells. 

3.  Describe  the  Vital  Properties  of  Cells. 

4.  Define  Epithelial  Tissue. 

5.  Define  Endothelium. 

6.  Name  the  Varieties  of  Connective  Tissue. 

7.  Define  Fibrous  Tissue. 

8.  Define  Elastic  Tissue,  its  Varieties. 

9.  Define  Adipose  Tissue. 

10.  Name  the  Varieties  and  Characters  of  Glandular  Tissue. 

11.  Describe  the  Structure  of  Glands. 

12.  Describe  the  Peculiarities  of  Epithelial  Tissue  and  of  En- 

dothelium . 

13.  Describe  the   Peculiarities  of    Connective,   Fibrous   and 

Elastic  Tissue. 

14.  Describe  the  Peculiarities  of  Adipose  Tissue. 

15.  Describe  the  Peculiarities  of  Glandular  Tissue. 

16.  Describe  the  Guide  to  Describe  an  Organ. 

DIGESTIVE   ORGANS. 

17.  Name  the  Organs  concerned  in  Digestion. 

18.  Describe  the  Structure  of  the  Lips. 

19.  Describe  the  Structure  of  the  Cheeks. 

20.  Describe  the  Vestibule. 

21.  Describe  the  Number  and  the  Shape  of  the  Teeth. 

22.  Describe  the  Structure  of  the  Teeth. 

23.  Describe  the  Gums. 

24.  Describe  the  Shape,  Base,  Surfaces  and  Tip  of  the  Tongue. 

25.  Describe  the  Structure  of  the  Tongue. 

26.  Describe  the  Hard  Palate. 

27.  Describe  the  Shape,   Surfaces  and  Borders  of  the  Soft 

Palate. 

28.  Describe  the  Structure  of  the  Soft  Palate. 

29.  Describe  the  Tonsils. 

30.  Describe  the  Shape,  Surfaces,  Borders,  Apex  and  Base  of 

the  Parotid. 

31.  Describe  the  Structure  of  the  Parotid. 

32.  Describe  the  Shape,  Surfaces  and  Extremities  of  the  Sub- 

maxillary Gland. 

33.  Describe  the  Structure  of  the  Submaxillary  Gland. 


QUESTIONS   ON  ANATOMY.  229 

34.  Describe  the  Shape.  Surfaces  and  Extremities  of  the  Sub- 

lingual Gland. 

35.  Describe  the  Structure  of  the  Sublingual  Gland. 

3(i.     Describe   the    Shape,    Surfaces,   Base    and    Apex    of    tin- 
Pharynx. 

37.  Describe  the  Structure  of  the  Pharynx. 

38.  Describe  the  Dimensions  and  Direction  of  the  (Esophagus. 

39.  Describe  the  Surfaces,   Borders   and   Extremities  of    the 

(Esophagus. 

40.  Describe  the  Structure  of  the  (Esophagus. 

41.  Describe  the  Shape  and  Walls  of  the  Cavity  of  the  Abdo- 

men. 

42.  Describe  the  Dividing-  Lines  of  the  Regions  of  the  Abdo- 

men. 

43.  Name  the  Organs  contained  in  the  Epigastric  aud   Hypo- 

chondriac Regions. 
44. '   Name  the  Organs  contained  in  the  Umbilical  and  Lumbar 
Regions. 

45.  Name  the  Organs  contained  in  the  Hypogastric  and  Iliac 

Regions. 

46.  Name  the  Divisions  of  the  Peritoneum. 

47.  Name  the  Folds  of  the  Peritoneum. 

48.  Name  the  Viscera  invested  or  not  invested  by  the  Perito- 

neum. 

49.  Describe  the  Shape,  Surfaces,  Borders  and  Extremities  of 

the  Stomach. 

50.  Describe  the  Structure  of  the  Stomach. 

51.  Describe  the  Shape,  Surfaces,  Borders  and  Extremities  of 

the  Duodenum. 

52.  Describe  the  Structure  of  the  Duodenum. 

53.  Describe  the  Shape,  Surfaces  and  Extremities  of  the  Jeju- 

num. 

54.  Describe  the  Structure  of  the  Jejunum. 

55.  Describe  the  Shape,  Surfaces  and  Extremities  of  the  Ileum. 
50.     Describe  the  Structure  of  the  Ileum. 

57.  Describe  the  Ca?cal  Appendix. 

58.  Describe   the    Shape,   Surfaces,    Apex    and    Base    of  the 

Caecum. 

59.  Describe  the  Structure  of  the  Caecum. 

60.  Describe  the   Shape.  Surfaces  and   Extremities  of  the  As- 

cending Colon. 

61.  Describe    the    Shape.    Surfaces    and    Extremities    of    the 

Transverse  Colon. 

62.  Describe  the  Shape.    Surfaces  and  Extremities  of  the  De- 

scending Colon. 

63.  Describe  the  Shape,  Surfaces  and  Extremities  of  the  Sig- 

moid Flexure. 

64.  Describe  the  Structure  of  the  Sigmoid  Flexure. 

65.  Describe  the  Shape.  Surfaces  and  Extremities  of  the  Rec- 

tum. 


230  QUESTIONS    ON  ANATOMY. 

66.  Describe  the  Structure  of  the  Rectum. 

67.  Describe  the  Shape,  Surfaces  and  Extremities  of  the  Auus. 

68.  Describe  the  Structure  of  the  Anus. 

69.  Describe  the  Peculiarities  of  the  Lips  and  Cheeks. 

70.  Describe  the  Peculiarities  of  the  Teeth  and  Gums. 

71.  Describe  the  Peculiarities  of  the  Tongue. 

72.  Describe  the  Peculiarities  of  the  Hard  and  of  the  Soft 

Palate. 

73.  Describe    the    Peculiarities    of    the   Tonsil   and   of    the 

Parotid. 

74.  Describe  the  Peculiarities  of  the  Submaxillary  and  Sub- 

lingual Glands. 

75.  Describe  the  Peculiarities  of  the  Pharynx. 

76.  Describe  the  Peculiarities  of  the  (Esophagus. 

77.  Describe  the  Peculiarities  of  the  Cavity  of  the  Abdomen 

and  Peritoneum. 

78.  Describe  the  Peculiarities  of  the  Stomach. 

79.  Describe  the  Peculiarities  of  the  Duodenum. 

80.  Describe  the  Peculiarities  of  the  Jejunum  and  of  the  Ileum. 

81.  Describe  the  Peculiarities  of  the  Ileo-csecal  Valve  and  of 

the  Caecal  Appendix. 

82.  Describe  the  Peculiarities  of  the  Csecum  and  of  the  Colons. 

83.  Describe  the  Peculiarities  of  the  Sigmoid  Flexure  and  of 

the  Rectum. 

84.  Describe  the  Peculiarities  of  the  Anus. 

85.  Describe   the    Peculiarities    and    Characteristics  of    the 

Mucous  Membrane  and  Digestive  Tract  to  the  (Esoph- 
agus inclusively. 

86.  Same  for  the  Stomach  to  the  Anus. 

87.  Describe  the  Shape,  Upper  Surface,  Upper  Border  and 

Lower  Border  of  Liver. 

88.  Describe  the  Extremities  and  the  Under  Surface  of  the 

Liver. 

89.  Describe  the  Structure  and  Excretory  Apparatus  of  the 

Liver. 

90.  Describe  the  Shape,  Surfaces,  Borders  and  Extremities  of 

the  Pancreas. 

91.  Describe  the  Structure  of  the  Pancreas. 

92.  Describe  the  Shape,  Surfaces,  Borders  and  Extremities  of 

the  Spleen. 

93.  Describe  the  Structure  of  the  Spleen. 

94.  Describe  the  Peculiarities  of  the  Liver. 

95.  Describe  the  Peculiarities  of  the  Pancreas. 

96.  Describe  the  Peculiarities  of  the  Spleen. 

URINARY  ORGANS. 

97.  Name  the  Urinary  Organs. 

98.  Describe  the  Supra-renal  Capsules. 

99.  Describe  the  Shape,  Surfaces,  Borders  and  Extremities  of 

the  Kidney. 


QUESTIONS   ON   ANATOMY.  S->\ 

100.  Describe  the  Structure  of  the  Kidney. 

101 .  Describe  the  Calices. 

102.  Describe  the  Pelvis  (Renal). 
10:5.  Describe  the  Ureter. 

104.  Describe  the  Shape  Surfaces.  Apex,  Base  and  Neck  of  the 

Bladder. 

105.  Describe  the  Structure  of  the  Bladder. 

106.  Describe  the  Prostate. 

107.  Describe  the  Peculiarities  of  the  Supra-renal  Capsules  and 

of  the  Kidneys. 

108.  Describe  the  Peculiarities  of  the  Excretory  Apparatus  of 

the  Kidneys. 

109.  Describe    the    Peculiarities  of  the    Ureters.   Bladder   and 

Prostate. 

110.  Name  the  Male  Organs  of  Generation. 

111.  Describe  the  Structure  of  the  Scrotum. 

112.  Describe  the  Testicle. 

113.  Describe  the  Epididymis. 

114.  Describe  the  Spermatic  Duct. 

115.  Describe  the  Structure  of  the  Spermatic  Cord. 

116.  Describe  the  Seminal  Vesicles. 

117.  Describe  the  Ejaculatory  Ducts. 

118.  Describe  the  Structure  of  the  Penis. 

119.  Describe  the  Male  Urethra. 

120.  Describe  Cowper's  Glands. 

121.  Describe  the  Peculiarities  of  the  Scrotum. 

122.  Describe  the  Peculiarities  of  the  Testicle  and  of  the  Epi- 

didymis. 

123.  Describe    the    Peculiarities  of  the  Spermatic  Duct,  Sper- 

matic Cord,   Seminal  Vesicles  and   Ejaculatory  Ducts. 

124.  Describe   the    Peculiarities    of    the    Penis,    of    the    Male 

Urethra  and  of  Cowper's  Glands. 

HEART. 

12.").     Describe  the  Fibrous  Pericardium. 

126.  Describe  the  Serous  Pericardium. 

127.  Describe  the  Shape,  Surfaces,  Borders.  Base  and  Apex  of 

the  Heart. 

128.  Describe  the  Structure  of  the  Heart. 

129.  Describe  the  Peculiarities  of  the  Pericardium  and  of  the 

Heart. 

ORGANS  OF  RESPIRATION. 

130.  Name  the  Organs  of   Respiration. 

131.  Describe  the  Shape,  Base,   Apex,  Borders,  and   Surfaces 

of  Larynx. 

132.  Describe  the  Structure  of  the  Larynx. 


232  QUESTIONS   ON  ANATOMY. 

133.  Describe  the   Shape,    Surfaces   and    Extremities   of   the 

Trachea. 

134.  Describe  the  Structure  of  the  Trachea. 

135.  Describe  the   Shape,    Surfaces   and   Extremities    of    the 

Bronchi. 

136.  Describe  the  Structure  of  the  Bronchi. 

137.  Describe  the  Shape,  Surfaces,  Borders,  Base  and  Apex  of 

the  Lungs. 

138.  Describe  the  Structure  of  the  Lungs. 

139.  Describe  the  Pleura. 

140.  Describe  the  Peculiarities  of.  the  Larynx. 

141.  Describe  the  Peculiarities  of  the  Trachea,  of  the  Bronchi, 

and  of  the  Lungs. 

142.  Describe  the  Peculiarities  of  the  Pleura. 

143.  Describe  the  Isthmus  of  the  Thyroid  Body. 

144.  Describe  the  Lobes  of  the  Thyroid  Body. 

145.  Describe  the  Structure  of  the  Thyroid  Body. 

146.  Describe  the  Thymus. 

147.  Describe  the  Peculiarities  of  the  Thyroid  Body  and  of  the 

Thymus. 


BRAIN  AND  SPINAL  CORD. 

148.  Name  the  Membranes  of  the  Brain. 

149.  Describe  the  Cerebral  Dura  Mater. 

150.  Describe  the  Cerebral  Arachnoid. 

151.  Describe  the  Cerebral  Sub-Arachnoid  Fluid. 

152.  Describe  the  Cerebral  Pia  Mater. 

153.  Name  the  Various  Parts  of  the  Brain. 

154.  Describe  the  Cerebrum. 

155.  Describe  the  Callous  Body. 

156.  Give  the  Boundaries  and  Divisions  of  the  Cavities  of  the 

Cerebrum. 

157.  Describe  the  Trigone. 

158.  Describe  the  Interposed  Veil. 

159.  Describe  the  Pellucid  Septum. 

160.  Describe  the  Lateral  Ventricles. 

161.  Describe  the  Middle  Ventricle. 

162.  Describe  the  Pineal  Gland. 

163.  Describe  the  Quadrigeminal  Bodies. 

164.  Describe  the  Shape,   Surfaces  and  Circumference  of  the 

Cerebellum. 

165.  Describe  the  Structure  of  the  Cerebellum. 

166.  Describe  the  Varoliaii  Bridge. 

167.  Describe  the  Shape,   Surfaces,    Base   and   Apex   of    the 

Oblong  Medulla. 

168.  Describe  the  Structure  of  the  Oblong  Medulla. 

169.  Describe  the  Surfaces  and  Angles  of  the  Cerebellar  Ven- 

tricle. 

170.  Define  the  Ependyma. 


QUESTIONS   ON   ANATOMY.  233 

171.  Describe  the  Ventricles. 

172.  Describe  the  Peculiarities  of  the  Envelopes  of  the  Brain. 

178.  Describe  the  Peculiarities  of  the  Cerebrum,  of  the  Pe- 
duncles, of  the  Callous  Body. 

174.     Describe  the  Peculiarities  of  the  Cavities  of  the  Cerebrum. 

17").  Describe  the  Peculiarities  of  the  Pineal  Gland,  of  the 
Quadrigeminal  Bodies,  of  the  Cerebellum,  of  the  Varo- 
lian  Bridge,  of  the  Oblong  Medulla  and  of  the  Cerebellar 
Ventricle. 

176.  Describe  the  Communication  of  the  Ventricles. 

177.  Name  the  Membranes  of  the  Spinal  Cord. 

178.  Describe  the  Dura  Mater  of  the  Spinal  Cord. 

179.  Describe  the  Arachnoid  of  the  Spinal  Cord. 

ISO.     Describe  the  Cerebro-spinal  Fluid  of  the  Spinal  Cord. 

181.  Describe  the  Pia  Mater  of  the  Spinal  Cord. 

182.  Describe  the   Shape,    Surfaces   and    Extremities   of    the 

Spinal  Cord. 

183.  Describe  the  Structure  of  the  Spinal  Cord. 

184.  Describe  the  Peculiarities  of  the  Envelopes  of  the  Spinal 

Cord. 

185.  Describe  the  Peculiarities  of  the  Spinal  Cord. 

186.  Describe  the  Shape,  Surfaces,  Borders  and  Extremities  of 

the  Nose. 

187.  Describe  the  Structure  of  the  Nose. 

188.  Describe  the  Shape,  Surfaces  and  Extremities  of  the  Nasal 

Cavities. 

189.  Describe  the  Structure  of  the  Mucous  Membrane  of  the 

Nasal  Cavities. 

190.  Describe  the  Peculiarities  of  the  Nose  and  Nasal  Cavities. 

191.  Name  the  Parts  Comprising  the  Eyeball. 

192.  Describe  the  Shape,    Surfaces  and   Circumference  of  the 

Cornea. 

193.  Describe  the  Structure  of  the  Cornea. 

194.  Describe  the  Sclerotic. 

195.  Describe   the  Shape,    Surfaces   and   Extremities   of    the 

Choroid. 

196.  Describe  the  Structure  of  the  Choroid. 

197.  Describe  the   Shape,    Surfaces   and   Extremities   of    the 

Retina. 

198.  Describe  the  Structure  of  the  Retina. 

199.  Describe  the  Vitreous  Body. 

200.  Describe  the  Shape,   Surfaces  and   Circumference  of  the 

Crystalline  Lens. 

201.  Describe  the  Structure  of  the  Crystalline  Lens. 

202.  Describe  the  Shape.  Surfaces  and  Circumference  of  the 

Iris. 

203.  Describe  the  Structure  of  the  Iris. 

204.  Describe  the  Aqueous  Humor. 

205.  Describe  the  Orbital  Fascia. 

206.  Describe  the  Muscles  of  the  Eyeball. 


234  QUESTIONS   ON  ANATOMY. 

207.  Describe  the  Structure  of  the  Eyelids. 

208.  Describe  the  Structure  of  the  Eyebrows. 

209.  Describe  the  Lachrjmial  Apparatus. 

210.  Describe  the    Peculiarities   of   the   Eyeball    and   of    its 

Envelopes. 

211.  Describe  the  Peculiarities  of  the  Contents  of  the  Eye- 

ball. 

212.  Describe  the  Peculiarities  of  the  Appendages  of  the  Eye. 

213.  Name  the  Parts  forming  the  Organs  of  Hearing. 

214.  Describe   the   Shape,    Surfaces   and   Extremities   of    the 

Pavilion. 

215.  Describe  the  Structure  of  the  Pavilion. 

216.  Describe  the  Direction,  Shape,  Surfaces,  Borders  and  Ex- 

tremities of  the  External  Auditory  Canal. 

217.  Describe  the  Structure  of  the  External  Auditory  Canal. 

218.  Describe  the  Drum  of  the  Ear. 

219.  Describe  the  Ossicles  of  the  Tympanum. 

220.  Describe  the  Lining  Membrane  of  the  Tympanum. 

221.  Describe  the  Mastoid  Cells. 

222.  Describe  the  Direction,  Shape,  Surfaces  and  Extremities 

of  the  Eustachian  Tube. 

223.  Describe  the  Structure  of  the  Eustachian  Tube. 

224.  Describe  the  Relative  Position  of  the  Parts  comprising 

the  Internal  Ear. 

225.  Describe  the  Shape  and  Surfaces  of  the  Vestibule. 

226.  Describe  the  Structure  of  the  Vestibule. 

227.  Describe   the   Shape,    Surfaces   and   Extremities   of    the 

Semi- circular  Canals. 

228.  Describe  the  Structure  of  the  Semi-circular  Canals. 

229.  Describe  the   Shape,    Base,    Apex  and  Surfaces  of    the 

Cochlea. 

230.  Describe  the  Structure  of  the  Cochlea. 

231.  Describe  the   Direction,  Shape,  Surfaces  and  Extremities 

of  the  Internal  Auditory  Canal. 

232.  Describe  the  Structure  of  the  Internal  Auditory  Canal. 

233.  Describe  the  Peculiarities  of    the  External   and  of  the 

Middle  Ears. 

234.  Describe  the  Peculiarities  of  the  Internal  Ear. 

235.  Name  the  Layers  of  the  Skin. 

236.  Describe  the  Hair  and  Follicle. 

237.  Name  the  Glands  of  the  Skin. 

238.  Describe  the  Structure  of  the  Nails. 

239.  Describe  the  Peculiarities  of  the  Skin. 

240.  Describe  the  Peculiarities  of  the  Glands  of  the  Skin. 

241.  Describe  the  Structure  of  Cartilage. 

242.  Describe  the  Varieties  of  Cartilage. 

243.  Describe  the  Chemical  Composition  of  Bones. 

244.  Describe  the  Structure  of  Bones. 

245.  Describe  the   Points   of  Special   Interest  concerning  the 

Cervical  Vertebra?  in  General. 


QUESTIONS   ON   ANATOMY.  235 

246.  Describe  the   First,  Second,  and  Seventh   Cervical  Verte- 

bras. 

247.  Describe  the  Dorsal  Vertebra'  in  General. 

248.  Describe  .the  First,  Ninth.  Tenth,  Eleventh   and  Twelfth 

Dorsal  Vertebra1. 

241).  Describe  the  Lumbar  Vertebrae. 

250.  Describe  the  Points  of  Special   Interest    Concerning  the 

Sacrum. 

251.  Describe  the  Spine  in  General. 

252.  Name  the  Bones  of  the  Skull. 

253.  Describe  the  Vertical  Portion  of  the  Frontal  Bone. 

254.  Describe  the  Horizontal  Portion  of  the  Frontal  Bone. 

255.  Describe  the  Lateral  Portions  of  the  Frontal  Bone. 
25(>.  Describe  the  Situation  of  the  Ethmoid. 

257.  Describe  the  Horizontal  Plate  of  the  Ethmoid. 

258.  Describe  the  Perpendicular  Plate  of  the  Ethmoid. 

259.  Describe  the  Lateral  Masses  of  the  Ethmoid. 

260.  Describe  the  Ethmoid  Cells. 

261.  Describe  the  Situation  of  the  Sphenoid. 

262.  Describe  the  Body  of  the  Sphenoid. 

263.  Describe  the  Lesser  Wings  of  the  Sphenoid. 

264.  Describe  the  Greater  Wings  of  the  Sphenoid. 

265.  Describe  the  Pterygoid  Process  of  the  Sphenoid. 

266.  Describe  the  Occipital  Bone. 

267.  Describe  the  Parietal  Bone. 

268.  Describe  the  Squamous  Portion  of  the  Temporal  Bone. 

269.  Describe  the  Mastoid  Portion  of  the  Temporal  Bone. 

270.  Describe  the  Petrous  Portion  of  the  Temporal  Bone. 

271.  Name  the  Bones  of  the  Face. 

272.  Describe  the  Vomer. 

273.  Describe  the  Superior  Maxillary  Bone. 

274.  Describe  the  Nasal  Bone. 

275.  Describe  the  Lachrymal  Bone. 

276.  Describe  the  Inferior  Turbinated  Bone. 

277.  Describe  the  Horizontal  Portion  of  the  Palate  Bone. 

278.  Describe  the  Vertical  Plate  of  the  Palate  Bone. 

279.  Describe  the  Malar  Bone. 

280.  Describe  the  Horizontal  Portion  of  the  Inferior  Maxilla. 

281.  Describe  the  Vertical  Portion  of  the  Inferior  Maxilla. 

282.  Give  a  Resume  of  the  Situation  of  the  Bones  of  the  Skull. 

283.  Give  a  Resume  of  the  Situation  of  the  Bones  of  the  Face. 

284.  Name  the  Sutures  of  the  Skull. 

285.  Name  the  Cranio-facial  Suture. 

286.  Describe  the  Upper  Region  or  Vertex  of  Skull. 

287.  Describe  the  Boundaries  of  the    Lateral   Regions  of  the 

Skull. 

288.  Describe  the  Mastoid  Region  of  the  Skull. 

289.  Describe  the  Temporal  Fossa. 

290.  Describe  the  Zygomatic  Fossa. 

291.  Describe  the  Pterygo-maxillary  Fossa. 


236  QUESTIONS   ON   ANATOMY. 

292.  Give  the  Boundaries  of  the  Inferior  Region  of  the  Exte- 

rior of  the  Skull. 

293.  Describe  the  Palato-pterygoid  Region  of  the  Skull. 

294.  Describe  the  Occipital  Region  of  the  Skull. 

295.  Describe  the  Sphenoidal  Region  of  the  Skull. 

296.  Describe  the  Petrous  Region  of  the  Skull. 

297.  Describe  the  Squamous  and  Mastoid  Regions  of  the  Skull. 

298.  Describe  the  Orbit. 

299.  Describe  the  Nasal  Fossae. 

300.  Describe  the  Divisions  and  the  Boundaries  of  the  Interior 

of  the  Skull. 

301.  Describe  the  Upper  Region  or  Roof  of  the  Interior  of  the 

Skull. 

302.  Describe  the  Anterior  or  Frontal  Cerebral  Fossa. 

303.  Describe  the  Middle  or  Sphenoidal  Fossa. 

304.  Describe  the  Posterior  or  Occipital  Fossa. 

305.  Describe  the  Foramens  of  the  Base  of  the  Interior  of  the 

Skull  and  the  Organs  Situated  therein. 

306.  Name  the  Points  of  Special  Interest  Concerning  the  Ribs. 

307.  Name  the  Points  of  Special  Interest  Concerning  the  First, 

Second,  Tenth,  Eleventh,  and  Twelfth  Ribs. 

308.  Name  the  Points  of  Special  Interest  Concerning  the  Ster- 

num . 

309.  Name  the  Points    of    Special    Interest  Concerning  the 

Clavicle. 

310.  Name  the   Points   of    Special    Interest  Concerning    the 

Scapula. 

311.  Name  the  Points  of    Special    Interest    Concerning   the 

Humerus. 

312.  Name  the  Points  of  Special  Interest  Concerning  the  Ulna. 

313.  Name  the    Points    of   Special    Interest   Concerning  the 

Radius. 

314.  Name  the    Points   of    Special    Interest    Concerning  the 

Carpus. 

315.  Name   the   Points    of    Special    Interest   Concerning  the 

Metacarpus. 

316.  Name    the    Points  of    Special  Interest    Concerning    the 

Phalanges. 

317.  Name    the   Points   of    Special   Interest  Concerning   the 

Innominate  Bone. 

318.  Name  the   Points   of    Special    Interest    Concerning  the 

Pelvis  in  General. 

319.  Name    the  Differences    Between  the   Male   and   Female 

Pelvis. 

320.  Name  the   Points    of   Special    Interest   Concerning    the 

Femur. 

321.  Name  the   Points    of    Special    Interest   Concerning  the 

Patella. 

322.  Name  the  Points  of  Special  Interest  Concerning  the  Tibia. 


QUESTIONS   ON   ANATOMY.  2:>7 

'■'>'2'-\.     Name  the    Points   of    Special    Interest    Concerning   the 
Fibula. 

324.  Name  the  Points  of  Special  Interest  Concerning  the  First 

Row  of  the  Tarsus. 

325.  Name  the  Points  of  Special  Interest  Con  jerning  tin-  Sec- 

ond Row  of  the  Tarsus. 

326.  Describe  the  Structure  of  Ligaments. 

327.  Describe  the  Structure  of    the  Synovial    Membranes   in 

General. 

328.  Describe  the  Classification  of  Joints. 

821).     Describe  the  Peculiarities  of  Each  Kind  of  .Joint. 

330.  Describe   the   Articulations    of    the     Bones    of  the    Ver- 

tex of  the  Skull. 

331.  Describe  the  Temporo-maxillarv  Articulation. 

382.  Describe  the  Articulations  of  the  Occipital  with  the  Atlas 
and  Axis. 

333.  Describe  the  Articulations  of  the  Vertebrae. 

334.  Describe  the  Articulations  of  the  Ribs. 

335.  Describe  the  Sterno-clavicular  Articulation. 

336.  Describe  the  Scapulo-humeral  Articulation. 

337.  Describe  the  Articulations  of  the  Elbow. 

338.  Describe  the  Upper  Ulno-Radial  Articulation. 

339.  Describe  the  Lower  Ulno-Radial  Articulation. 

340.  Describe  the  Radio-carpal  Articulation  of  Wrist  Joint. 

341.  Describe  the  Intercarpal  Articulations. 

342.  Describe  the  Sacro-iliac  Articulation. 

343.  Describe  the  Symphysis  Pubis  Articulation. 

344.  Describe  the  Coxo-femoral  Articulation. 

345.  Describe  the  Knee  Joint  or  Tibio-femoral  Articulation. 

346.  Describe  the  Upper  Tibio-Peroneal  Articulation. 

347.  Describe  the  Ankle  Joint  or  Tibio-tarsal  Articulation. 

348.  Describe  the  Articulations  of  the   Astragalus  and  Calca- 

neum. 

349.  Describe  the  Articulations  between  First  and  Second  Rows 

of  the  Tarsus. 

350.  Describe  the  Articulations  of  the  Metatarsus. 

351.  Describe  the  Structure  of  Muscular  Tissue. 

352.  Describe  the  Structure  of  Tendons. 

353.  Describe  the  Structure  of  Aponeuroses  and  Fascia?. 

354.  Describe  the  Muscles  of  the  Cranial,  Auricular,  and   Pal- 

pebral Regions. 

355.  Describe  the  Muscles  of  the  Nasal  Region. 

356.  Describe  the  Muscles  of  the  Buccal  or  Oral  Region. 

357.  Describe  the  Muscles  of  the  Temporo-maxillarv  Region. 

358.  Describe  the  Muscles  of  the  Superficial  Region  of  the  Neck. 

359.  Describe  the  Muscles  of  the  Supra-hyoid  Region. 

360.  Describe  the  Muscles  of  the  Anterior  Vertebral  Region. 

361.  Describe  the  Muscles  of  the  Lateral  Vertebral  Region. 

362.  Describe  the  Muscles  of  the  First.  Second  and  Third  Lay- 

ers of  the  Back. 


238  QUESTIONS   ON  ANATOMY. 

363.  Describe  the  Muscles  of  the  Fourth  Layer  of  the  Back. 

364.  Describe  the  Muscles  of  the  Fifth  Layer  of  the  Back. 

365.  Describe  the  Muscular  Layers  of  the  Neck. 

366.  Describe  the  Muscles  of  the  Chest. 

367.  Describe  the  Muscles  of  the  Shoulder. 

368.  Describe  the  Muscles  of  the  Anterior  Region  of  the  Arm. 

369.  Describe  the  Muscles  of  the  Posterior  Region  of  the  Arm. 

370.  Describe  the  Muscles  of  the  Anterior  Region  of  the  Fore- 

arm. 

371.  Describe  the  Muscles  of  the  External  or  Radial  Region  of 

the  Forearm. 

372.  Describe  the  Muscles  of  the  Superficial  Layer  of  the  Pos- 

terior Region  of  the  Forearm. 

373.  Describe  the  Muscles  of  the  Deep  Layer  of  the  Posterior 

Region  of  the  Forearm. 

374.  Describe  the  Muscles  of  the  External  Region  of  the  Hand. 

375.  Describe  the  Muscles  of  the  Internal  Region  of  the  Hand. 

376.  Describe  the  Muscles  of  the  Middle  or  Palmar  Region  of 

the  Hand. 

377.  Describe  the  Muscles  of  Exterior  of  the  Abdomen. 

378.  Describe  the  Muscles  of  the  Interior  of  the  Abdomen. 

379.  Describe  the  Muscles  of  the  Anterior  Region  of  the  Thigh 

380.  Describe  the  Muscles  of  the  Internal  Region  of  the  Thigh 

381.  Describe  the  Muscles  of  the  Anterior  Region  of  the  Leg 

382.  Describe  the  Muscles  of  the  External  Region  of  the  Leg 

383.  Describe  the  Muscles  of  the  Dorsal  Region  of  the  Foot. 

384.  Describe  the  Muscles  of  the  Gluteal  Region. 

385.  Describe   the   Muscles   of   the   Posterior  Region   of    the 

Thigh. 

386.  Describe  the  Muscles  of  the  Posterior  Region  of  the  Leg. 

387.  Describe  the  Muscles  of  the  Internal  Regions  of  the  Foot. 

388.  Describe  the  Muscles  of  the  External  Plantar  Region. 

389.  Describe  the  Muscles  of  the  Middle  Plantar  Region. 

390.  Describe  the  Peculiarities  of  the  Muscles  of  the  Back,   of 

the  Cranial  Region,  of  the  Face,  of  the  Temporo-maxil- 
lary  Region,  and  of  the  Ptery  go -maxillary  Region. 

391.  Describe  the  Peculiarities  of  the  Muscles  of  the  Neck  and 

of  the  Chest. 

392.  Describe  the  Peculiarities  of  the  Muscles  of  the  Shoulder 

and  of  the  Arm. 

393.  Describe  the  Peculiarities  of  the  Muscles  of  the  Forearm 

and  Hand. 

394.  Describe  the  Peculiarities  of  the  Muscles  of  the  Vertebral 

Region  and  of  the  Abdomen. 

395.  Describe  the  Peculiarities  of  the  Muscles  of  the  Interior 

of  the  Pelvis,  of  the  Anterior  and  Internal  Regions  of 
the  Thigh,  of  the  Anterior  and  External  Regions  of  the 
Leg,  and  of  the  Back  of  the  Foot. 

396.  Describe  the  Peculiarities  of  the  Muscles  of  the  Gluteal 

Region,  of  the  Posterior  Region  of  the  Thi^h,  of  the 


QUESTIONS   ON   ANATOMY.  239 

Posterior  Reg-ion  of  the  Leg,  and  of  the  Muscles  of  the 
Plantar  Region. 

397.  Name  the  Muscles  which  are  Specially  Interesting  or  Im- 

portant. 

398.  Name  the  Muscles  of  Special  Surgical  Importance. 

399.  Name  the  Anatomical  Elements  of  the  Blood. 

400.  Describe  the  Red  Blood  Corpuscles. 

401.  Describe  the  White  Blood  Corpuscles. 

401'.     Describe  the  Blood  Plates  and  the  Free  Nuclei. 

403.  Describe  the  General  Structure  of  Arteries. 

404.  Describe  the  Structure  of   Arteries  in  Particular,  accord- 

ing to  Size. 

405.  Describe  the  Structure  of  Veins. 

406.  Describe  the  Structure  of  Capillaries. 

407.  Describe  the  Divisions  of  the  Systemic  Circulation  and  the 

Cardiac  Circulation. 

408.  Describe  the  Pulmonary  and  Bronchial  Circulations. 

409.  Describe  the  Aorta. 

410.  Describe  the  Branches  of  the  Arch  of  the  Aorta. 

411.  Describe  the  Common  Carotid. 

412.  Describe   the   Situation  and  Course  of  the  External  Car- 

otid. 

413.  Describe  the  Branches  of  the  External  Carotid. 

414.  Describe  the  Situation  and  Course  of  the  Internal  Carotid. 

415.  Describe  the  Branches  of  the  Internal  Carotid. 

416.  Describe  the  Situation  and  Course  of  the  Subclavian  Ar- 

tery. 

417.  Describe  the  Branches  of  the  Subclavian  Artery. 

418.  Describe  the  Situation  and  Course  of  the  Axillary  Artery. 

419.  Describe  the  Branches  of  the  Axillary  Artery. 

420.  Describe  the  Situation  and  Course  of  the  Brachial  Artery. 

421.  Describe  the  Branches  of  the  Brachial  Artery. 

422.  Describe  the  Radial  Artery. 

423.  Describe  the  Situation  and  Course  of  the  Ulnar  Artery. 

424.  Describe  the  Branches  of  the  Ulnar  Artery. 

425.  Describe  the  Branches  of  the  Thoracic  Aorta. 
420.  Describe  the  Branches  of  the  Abdominal  Aorta. 

427.  Describe  the  Common  Iliac  Artery. 

428.  Describe  the  Situation   and  Course  of  the  Internal  Iliac 

Artery. 

429.  Describe  the  Branches  of  the  Internal  Iliac  Artery. 

430.  Describe  the  Situation  and  Course  of  the  External   Iliac 

Artery. 

431.  Describe  the  Branches  of  the  External  Iliac  Artery. 

432.  Describe  the  Situation  and  Course  of  the  Femoral  Artery. 

433.  Describe  the  Branches  of  the  Femoral  Artery. 

434.  Describe  the  Situation  and  Courseof  the  Popliteal  Artery. 

435.  Describe  the  Branches  of  the  Popliteal  Artery. 
430.  Describe  the  Anterior  Tibial  Artery. 

437.     Describe  the  Dorsal  Artery  of  the  Foot. 


240  QUESTIONS    ON   ANATOMY. 

438.  Describe  the  Posterior  Tibial  Artery. 

439.  Describe  the  External  Plantar  Artery. 

440.  Describe  the  Internal  Plantar  Artery. 

441.  Describe  the  Peculiarities  of  the  Innominate  Artery,  the 

Carotids  and  the  Subclavian. 

442.  Describe  the   Peculiarities   of   the   Brachial   Artery,  the 

Radial  and  Ulnar. 

443.  Describe  the  Peculiarities  of  the  Aorta,  the  Iliac  Arteries, 

the  Femoral,  Popliteal  and  Tibials. 

444.  Describe  the  Peculiarities  of  the  Arteries  of  the  Organs 

of  Digestion. 

445.  Describe  the  Peculiarities  of  the  Arteries  of  the  Organs  of 

Urination  and  Generation. 
44G.     Describe  the  Peculiarities  of  the  Arteries  of  the  Heart,  of 
the  Organs  of  Respiration  and  of  Innervation. 

447.  Describe  the  Peculiarities  of  the  Arteries  of  the  Organs 

of  Special  Sense  and  of  the  Organs  of  Locomotion  and 
Circulation. 

448.  Describe  the  Lines  Indicating  the  Direction  of,   and  the 

Muscle  which  is  the  Guide  to,  the  Innominate  Artery,  the 
Common,  External,  and  Internal  Carotid  Arteries,  the 
Bifurcation  of  the  Common  Carotid  Artery,  the  Lingual 
and  the  Facial  Arteries. 

449.  Describe  the  Lines  Indicating  the  Direction  of,  and  the 

Muscle  which  is  the  Guide  to,  the  Subclavian,  the  Axil- 
lary, the  Subscapular,  the  Brachial  Arteries,  and  Radial 
Artery  in  the  Forearm. 

450.  Describe  the  Lines  Indicating  the  Direction  of,  and  the 

Muscle  which  is  the  Guide  to,  the  Radial  Artery,  the 
Ulnar  and  the  Palmar  Arches. 

451.  Describe  the  Lines  Indicating  the  Direction  of,  and  the 

Muscle  which  is  the  Guide  to,  the  Internal  Mammary 
Artery,  the  Epigastric,  the  Common  Iliac,  the  External 
Iliac,  the  Gluteal  Artery. 

452.  Describe  the  Lines  Indicating  the  Direction  of,  and  the 

Muscle  which  is  the  Guide  to,  the  Internal  Pudic  Artery, 
the  Ischiatic,  the  Bulbous  and  the  Femoral. 

453.  Describe  the  Lines  Indicating  the  Direction  of,  and  the 

Muscle  which  is  the  Guide  to,  the  Popliteal  Artery,  the 
Anterior  Tibial,  the  Dorsal  Artery,  the  Posterior  Tibial, 
the  Peroneal  and  the  Plantar  Arch. 

454.  Describe  the  Supra-diaphragmatic  Circulatory  Circuits. 

455.  Describe  the  Infra-diaphragmatic  Circuits. 

456.  Describe  the  Articular  Arterial  Circles. 

457.  Enumerate    the    Most    Important    Branches   of  Arteries 

Necessary  to  Understand  the  Establishment  of  the 
Collateral  Circulation  after  the  Ligature  of  Arteries 
Above  the  Arch. 

458.  Same  of  the  Arteries  Below  the  Arch. 


QUESTIONS   ON   ANATOMY.  241 

4.")<).     Surgical  Col  lateral  Branches  of  the  Main  Arteries  Above 
the  Arch. 

4(H).     Surgical  Collateral  Branches  of  the  Main  Arteries  Below 
the  Arch . 

461.  Describe  the  Collateral  Circulation  after  the  Ligature  of 

the  Innominate  and  of  the  Carotids. 

462.  Describe  the  Collateral  Circulation  after  the  Ligature  of 

the  Subclavian  and  of  the  Axillary. 

463.  Describe  the  Collateral  Circulation  after  the  Ligature  of 

the  Brachial,  Radial  and  Ulnar. 

464.  Describe  the  Collateral  Circulation  after  the  Ligature  of 

the  Iliacs. 

465.  Describe  the  Collateral  Circulation  after  the  Ligature  of 

the  Femorals,  Popliteal,  Tibials. 

466.  Describe  the  Ascending  Cava  Vein. 

467.  Describe  the  Left  Innominate  Vein. 

468.  Describe  the  Right  Innominate  Vein. 

469.  Describe  the  Internal  Jugular  Vein. 

470.  Describe  the  Lateral  Sinuses. 

471.  Describe  the  Superior  Longitudinal  Sinus. 

472.  Describe  the  Straight  Sinus. 

473.  Describe  the  Occipital  Sinuses. 

474.  Describe  the  Cavernous  Sinuses. 

475.  Describe  the  Classification  of  the  Sinuses. 

476.  Describe  the  Anastomoses  Between  the  Intra-cranial  and 

the  Extra-cranial  Venous  Circulation. 

477.  Describe  the  Subclavian  Vein. 

478.  Describe  the  Axillary  Vein. 

479.  Describe  the  Ascending  Cava  Vein. 

480.  Describe  the  Common  Iliac  Vein. 

481.  Describe  the  Internal  and  External  Iliac  Vein. 

482.  Describe  the  Femoral  Vein. 

483.  Describe  the  Popliteal  Vein. 

484.  Describe  the  Branches  of  the  Popliteal  Vein. 

485.  Describe  the  Peculiarities  of  Veins  in  Particular,  to  the 

Veins  of  the  Face  Inclusively. 

486.  Describe  the  Peculiarities  of  the  Veins  of  the  Neck  and 

of  the  Remainder  of  the  Veins. 

487.  Describe  the  Peculiarities  of  the  Veins  of  Some  Organs. 

to  the  Veins  of  the  Liver  Inclusively. 

488.  Describe  the  Peculiarities  of  the  Veins  of  the   Organs  of 

Urination  and  Generation. 

489.  Describe  the  Peculiarities  of  the  Veins  of  the  Eeart. 

490.  Describe  the  Peculiarities  of  the  Veins  of  the  Organs  of 

Respiration. 

491.  Describe  the   Peculiarities    of   the   Wins   of  the   Central 

Organs  of  Innervation. 

492.  Describe  the   Peculiarities  of  the  Veins  of  the  Organs  of 

Special  Sense. 


242  QUESTIONS    ON   ANATOMY. 

493.  Describe  the  Peculiarities  of  Veins  of  the  Bones,  Muscles 

and  Vessels. 

494.  Describe  the  Structure  of  Lymphatic  Vessels. 

495.  Describe  the  Structure  of  Lymphatic  Glands. 

496.  Describe  the  Lymph. 

497.  Describe  the  Chyle. 

498.  Describe  the  Thoracic  Duct. 

499.  Describe  the  Right  Lymphatic  Duct. 

500.  Describe  the  Lymphatic  Glands  of  the  Head. 

501.  Describe  the  Lymphatic  Glands  of  the  Neck. 

502.  Describe  the  Lymphatic  Glands  of  the  Upper  Extremity. 

503.  Describe  the  Lymphatic  Glands  of  the  Chest. 

504.  Describe  the  Lymphatic  Glands  of  the  Abdomen. 

505.  Describe  the  Lymphatic  Glands  of  the  Pelvis. 

506.  Describe  the  Lymphatic  Glands  of  the  Lower  Extremity. 

507.  Describe  the  Peculiarities  of  the  Lymphatics. 

508.  Describe   the    Peculiarities    of    the    Lymphatics   of  the 

Tissues. 

509.  Describe    the    Peculiarities   of    the   Lymphatics    of   the 

Organs  of  Digestion. 

510.  Describe  the  Peculiarities  of  the  Lymphatics  of  the  Or- 

gans of  Urination  and  of  Generation. 

511.  Describe  the  Peculiarities  of  the  Lymphatics  of  the  Or- 

gans of  Respiration  and  of  Innervation. 

512.  Describe  the  Peculiarities  of  the  Lymphatics  of  the  Or- 

gans of  Special  Sense. 

513.  Describe  the     Peculiarities    of    the   Lymphatics   of   the 

Organs  of  Locomotion. 

514.  Describe  the  Structure  of  Nerves. 

515.  Describe  the  Termination  of  Nerves. 

516.  Describe  the  Structure  of  Nervous  Ganglia. 

517.  Describe  the  Olfactory  Nerve. 

518.  Describe  the  Optic  Nerve. 

519.  Describe  the  Common  Ocular  Motor. 

520.  De*scribe  the  Pathetic  Nerve. 

521.  Describe  the  Tri-facial. 

522.  Describe  the  Ophthalmic,  Superior  Maxillary  and  Inferior 

Maxillary  Nerve. 

523.  Describe  the  External  Ocular  Motor. 

524.  Describe  the  Facial. 

525.  Describe  the  Auditory. 

526.  Describe  the  Glossopharyngeal. 

527.  Describe  the  Pneumo-gastric. 

528.  Describe  the  Spinal  Accessory. 

529.  Describe  the  Hypoglossal. 

530.  Describe  the  Spinal  Nerves  (Roots). 

531.  Describe  the  Cervical  Plexus. 

532.  Describe  the  Brachial  Plexus  and  Branches. 

533.  Describe  the  Intercostal  Nerves. 

534.  Describe  the  Lumbar  Plexus  and  Branches. 

535.  Describe  the  Sacral  Plexus  and  Branches. 


QUESTIONS.  ON   ANATOMY. 


24!! 


536.  Describe  the  Great  Sympathetic  Nerve. 

537.  Describe   the  Peculiarities   of  the  Olfactory  Nerve,   the 

Optic,  the  Common  Ocular  Motor  and  Pathetic. 

538.  Describe  the  Peculiarities  of  the  Tri-facial,  the  External 

Ocular  Motor,  the  Facial  and  the  Auditory. 

539.  Describe  the  Peculiarities  of   the  Glossopharyngeal,  the 

Pneumo -gastric,  the  Spinal  Accessory  and  the  Hypo- 
glossal. 

540.  Describe  the  Peculiarities  of  the  Spinal  Nerves. 

541.  Describe  the  Peculiarities  of  the  Intercostal  Nerves,  of 

the  Lumbar  and  Sacral  Plexus  and  Branches. 

542.  Describe  the  Points  of  Special  Interest  Connected  with 

the  Region  of  the  Skull. 

543.  Describe  the  Points  of  Special  Interest  Connected  with 

the  Region  of  the  Face. 

544.  Describe  the  Points  of  Special  Interest  Connected  with 

the  Zygomatic  and  Pterygo-maxillary  Fossae. 

545.  Describe  the  Points  of  Special  Interest  Connected  with 

the  Region  of  the  Parotid. 
.546.     Describe  the  Points  of   Special  Interest  Connected  with 
the  Region  of  the  Carotids. 

547.  Describe  the  Points  of  Special  Interest  Connected  with 

the  Lateral  Supra-hyoid  Region. 

548.  Describe  the  Points  of  Special  Interest  Connected  with 

the  Anterior  Mediastinum. 

549.  Describe  the  Points  of  Special  Interest  Connected  with 

the  Superior  Mediastinum. 

550.  Describe  the  Points  of  Special  Interest  Connected  with 

the  Supra-clavicular  Region. 

551.  Describe  the  Points  of  Special  Interest  Connected  with 

the  Infra-clavicular  Region. 

552.  Describe  the  Points  of    Special  Interest  Connected  with 

the  Axillary  Region. 

553.  Describe  the  Points  of  Special  Interest  Connected  with 

the  Internal  Region  of  the  Arm. 

554.  Describe  the  Points  of   Special  Interest  Connected  with 

the  Bend  of  the  Elbow. 

555.  Describe  the  Points  of  Special  Interest  Connected  with 

the  Region  of  the  Wrist. 

556.  Describe  the  Points  of  Special  Interest  Connected  with 

the  Region  of  the  Palm  of  the  Hand. 

557.  Describe  the  Points  of  Special  Interest  Connected  with 

the  Posterior  Mediastinum. 

558.  Describe  the  Points  of  Special  Interest  Connected  with 

the  Lateral  Region  of  the  Back. 

559.  Describe  the  Points  of  Special  Interest  Connected  with 

the  Middle  Region  of  the  Back,  or  Spinal  Region. 

560.  Describe  the  Organs  Contained   in   the    Region   of    the 

Abdomen. 

561.  Describe  the  Points  of  Special  Interest  Concerning  the 

Male  Perineum. 


244  QUESTIONS   ON  ANATOMY. 

562.  Describe  the  Points  of  Special  Interest;..Gbucerning  the 

Inguinal  Region. 

563.  Describe    the    Points    of    Special    Interest    Concerning 

SearpaTs  Triangle. 

564.  Describe  the  Points  of  Special  Interest  Concerning  the 

Internal  Region  of  the  Thigh. 

565.  Describe  the  Points  of  Special  Interest  Concerning  the 

Dorsal  Region  of  the  Foot. 

566.  Describe  the  Points  of  Special  Interest  Concerning  the 

Upper  Coxo-femoral  and  Gluteal  Regions. 

567.  Describe  the  Points  of  Special  Interest  Concerning:  the 

Popliteal  Region. 

568.  Describe  the  Points  of  Special  Interest  Concerning  the 

Internal  Malleolar  Region.. 

569.  Describe  the  Points  of  Special  Interest  Concerning  the 

Plantar  Region. 

570.  Describe  the  Vitelline  Membrane. 

571.  Describe  the  Mulberry  Mass. 

572.  Describe  the  Deciduee. 

573.  Describe  the  Vitelline  Chorion. 

574.  Describe  the  Blastoderm. 

575.  Describe  the  Amnion. 

576.  Describe  the  Blastodermic  Chorion. 

577.  Describe  the  Umbilical  Cord  and  its  Vessels. 

578.  Describe  the  Allantois. 

579.  Describe  the  Allantoid  Chorion. 

580.  Describe  the  Permanent  Chorion. 

581.  Describe  the  Placenta. 

582.  Describe  the  Umbilical  Cord. 

583.  Describe  the  Development  of  the  First  Trace  of  the  Em- 

bryo, the  Vertebral  Gutter,  the  Abdominal  Cavity,  the 
Limbs,  the  Face,  Nose,  Lips,  Drum  of  the  Ear,  Eusta- 
chian Tube,  External  Auditory  Canal  and  External  Ear, 
and  the  Teeth. 

584.  Describe  the  Development  of  the  (Esophagus,  Stomach, 

Intestines,  Rectum,  Liver,  Spleen,  Pancreas. 

585.  Describe  the  Development  of  the  Urinary  Organs. 

586.  Describe   the   Development  of    the   Internal   Organs   of 

Generation. 

587.  Describe   the   Development  of    the   External   Organs  of 

Generation. 

588.  Describe  the  Development  of  the  Heart. 

589.  Describe  the  Development  of  the  Spinal  Cord  and  Brain. 

590.  Describe    the   Development   of    the   Organs    of    Special 

Sense. 

591.  Describe  the  Development  of  the  Bones  and  Muscles. 

592.  Describe  the  Laws  of  Development. 

593.  Describe  the  Epoch  of  Appearance  of  the  Main  Organs 

and  the  Condition  of  the  Cranium  at  Birth. 

594.  Describe  the  Appearance  at  Birth  of  the  Bones  of   the 

Cranium.  ^  0 


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